Healthcare Provider Details

I. General information

NPI: 1346559762
Provider Name (Legal Business Name): BEHAVIOR MATTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2010
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16636 BAIRD CIR
EAGLE RIVER AK
99577-6711
US

IV. Provider business mailing address

16941 N EAGLE RIVER LOOP RD STE 3
EAGLE RIVER AK
99577-7824
US

V. Phone/Fax

Practice location:
  • Phone: 253-686-6958
  • Fax: 907-726-5366
Mailing address:
  • Phone: 253-686-6958
  • Fax: 907-726-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7144
License Number State

VIII. Authorized Official

Name: MRS. REBEKA PENA EDGE
Title or Position: BCBA
Credential: M. ED, BCBA
Phone: 253-686-6958