Basic Information
| Provider Information | |||||||||
| NPI: | 1871001719 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROWN BEAR BEHAVIORAL CONSULTING | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80933 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997080933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145808260 | ||||||||
| FaxNumber: | 8142869120 | ||||||||
| Practice Location | |||||||||
| Address1: | 1806 COLVILLE STREET #6 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997750001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145808260 | ||||||||
| FaxNumber: | 8142869120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2018 | ||||||||
| LastUpdateDate: | 01/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOWLAND | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER & BCBA | ||||||||
| AuthorizedOfficialTelephone: | 8145808260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | MS, BCBA, LBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 125001 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.