Basic Information
| Provider Information | |||||||||
| NPI: | 1346559762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIOR MATTERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16636 BAIRD CIR | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995776711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536866958 | ||||||||
| FaxNumber: | 9077265366 | ||||||||
| Practice Location | |||||||||
| Address1: | 16636 BAIRD CIR | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995776711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536866958 | ||||||||
| FaxNumber: | 9077265366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2010 | ||||||||
| LastUpdateDate: | 09/19/2011 | ||||||||
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| AuthorizedOfficialLastName: | EDGE | ||||||||
| AuthorizedOfficialFirstName: | REBEKA | ||||||||
| AuthorizedOfficialMiddleName: | PENA | ||||||||
| AuthorizedOfficialTitleorPosition: | BCBA | ||||||||
| AuthorizedOfficialTelephone: | 2536866958 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M. ED, BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-10-7144 | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1265734230 | 01 | NPI | OTHER | 1265744247 | 01 | NPI | OTHER | 1245530757 | 01 | NPI | OTHER | 1720304173 | 01 | AK | NPI | OTHER |