Active NPI
Lia Violet Becktold, M.ED., BCBA
- Behavior Analyst
- Glendale, AZ
National Provider Identifier
1760855696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BEH-000212
- Practice address
- 5859 W Talavi Blvd Ste 180
Glendale, AZ 85306-1873 - Phone
- (602) 560-2836
- Fax
- (317) 520-8200
- NPI assigned
- Oct 30, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BEH-000212 | AZ | Primary |
Addresses
Primary practice location
5859 W Talavi Blvd Ste 180
Glendale, AZ 85306-1873
Mailing address
3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135
Phone (855) 324-0885
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OTC6521 | Medicaid | AZ | |
| 1-15-19569 | Other | BCBA CERTIFICATE |
Other names 1
- Lia Triboulet
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BEH-000212 | AZ | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578009600000",
"number": "1760855696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 DEPAUW BLVD STE 3070",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462686135",
"telephone_number": "855-324-0885",
"fax_number": "317-520-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5859 W TALAVI BLVD STE 180",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853061873",
"telephone_number": "602-560-2836",
"fax_number": "317-520-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BECKTOLD",
"first_name": "LIA",
"middle_name": "VIOLET",
"credential": "M.ED., BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-30",
"last_updated": "2020-01-03",
"certification_date": "2020-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AZ",
"license": "BEH-000212",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OTC6521",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBA CERTIFICATE",
"identifier": "1-15-19569",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LIA",
"last_name": "TRIBOULET",
"credential": "M.ED., BCBA",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.