Individual
ELIZABETH ROSE TIBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, BCBA, COBA
Contact information
Practice address
3771 S A ST, RICHMOND, IN 47374-6053
(765) 598-4197
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-20-42623
IN
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-42623
BCBA CERTIFICATE
—
Enumeration date
07/06/2020
Last updated
10/12/2021
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