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NPI Code Detail

MEDICARE: MOMENTUM BEHAVIORAL SERVICES LLC

MEDICARE: MOMENTUM BEHAVIORAL SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1164835989
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOMENTUM BEHAVIORAL SERVICES LLC
Provider Business Mailing Address
First Line : 1801 E JEFFERSON ST
Second Line :
City : SEATTLE
State : WA
Zip : 98122-5743
Country : US
Telephone Number : 206-552-6724
Fax Number :
Provider Business Practice Location Address
First Line : 2317 24TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-2606
Country : US
Telephone Number : 206-552-6724
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : MR. NEILL DORN
Credential : BCBA
Telephone Number : 206-552-6724
Provider Enumeration Date : 06/09/2014
Last Update Date : 04/23/2018

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Directions to “MOMENTUM BEHAVIORAL SERVICES LLC ” Practice Location

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