Basic Information
| Provider Information | |||||||||
| NPI: | 1659889491 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEHAVIOR NATION LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3867 COTTONWOOD DR | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945066007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258542468 | ||||||||
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| Practice Location | |||||||||
| Address1: | 412 JEFFERSON PKWY STE 202 | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970351252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884283223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2018 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | RUSHAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8442628466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 106E00000X | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.