1417510405 NPI number — APPLIED BEHAVIORAL INTERVENTIONS PLLC

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 1417510405 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:
1417510405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10000 N 31ST AVE
Provider Second Line Business Mailing Address:
A107
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-441-2388
Provider Business Mailing Address Fax Number:
800-881-7571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 N. 31ST AVENUE 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
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:
04/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
ROXANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
602-441-2388

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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