1538459151 NPI number — ACTIVE LEARNERS BEHAVIORAL CONSULTING, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538459151 NPI number — ACTIVE LEARNERS BEHAVIORAL CONSULTING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTIVE LEARNERS BEHAVIORAL CONSULTING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538459151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2613 NW 30TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-7603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-808-3946
Provider Business Mailing Address Fax Number:
405-285-6681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S BOULEVARD STE 126
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73034-3880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-808-3946
Provider Business Practice Location Address Fax Number:
405-285-6681
Provider Enumeration Date:
04/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MILTON
Authorized Official First Name:
JEANNA
Authorized Official Middle Name:
LORAY
Authorized Official Title or Position:
BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official Telephone Number:
405-808-3946

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-10-7508 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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