1346559762 NPI number — BEHAVIOR MATTERS LLC

Table of content: (NPI 1346559762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346559762 NPI number — BEHAVIOR MATTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIOR MATTERS 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:
1346559762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16941 N EAGLE RIVER LOOP RD STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE RIVER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99577-7824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-686-6958
Provider Business Mailing Address Fax Number:
907-726-5366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16636 BAIRD CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE RIVER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99577-6711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-686-6958
Provider Business Practice Location Address Fax Number:
907-726-5366
Provider Enumeration Date:
10/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EDGE
Authorized Official First Name:
REBEKA
Authorized Official Middle Name:
PENA
Authorized Official Title or Position:
BCBA
Authorized Official Telephone Number:
253-686-6958

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-10-7144 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1265734230 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1265744247 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1245530757 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1720304173 . This is a "NPI" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".