1619321908 NPI number — APPLIED BEHAVIORAL INTERVENTIONS, PLLC

Table of content: (NPI 1619321908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619321908 NPI number — APPLIED BEHAVIORAL INTERVENTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLIED BEHAVIORAL INTERVENTIONS, PLLC
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:
1619321908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 72657
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85050-1028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-524-0824
Provider Business Mailing Address Fax Number:
800-881-7511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 N 31ST AVE STE A107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85051-9582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-441-2388
Provider Business Practice Location Address Fax Number:
800-881-7511
Provider Enumeration Date:
04/22/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OKORIE
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
602-441-2388

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LISAC-15037 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC-13418 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 4010 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW-10962 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: CSLG7643 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: BH4777 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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