Marybeth Gundlach, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-16-23872

Practice address

1408 Bismark Dr Unit B
Powell, WY 82435-9195

Phone

(385) 224-0349

NPI assigned

Oct 10, 2016

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Big Horn Behavior Consulting

  • Behavior Analyst
  • Powell, WY
  • NPI 1124532288
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1811447295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 BISMARK DR UNIT B",
            "city": "POWELL",
            "state": "WY",
            "postal_code": "824359195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 BISMARK DR UNIT B",
            "city": "POWELL",
            "state": "WY",
            "postal_code": "824359195",
            "telephone_number": "385-224-0349"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2378 Woodlake Dr",
            "address_2": "Suite 280",
            "address_purpose": "LOCATION",
            "city": "Okemos",
            "state": "MI",
            "postal_code": "488646013",
            "country_code": "US",
            "telephone_number": "517-706-0421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUNDLACH",
        "first_name": "MARYBETH",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-10",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "1-16-23872",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-16-23872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Aline Graham, LCSW
• Shelly Eyre Graham, PHD
• Travis Graham, PHARMD
• Emily Kay Green, LCSW
• Guardian Flight LLC
• Erica Christine Hall, M.A., CCC-SLP
• Michele Diane Hampton
• Tasha Hancock
• Jeffrey N Hansen, M.D.
• Adrienne M Harvey, OTR/L

• Behavior Analyst in Powell, WY
• Providers in Powell, WY by specialty
• Behavior Analyst in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.