Healthcare Provider Details

I. General information

NPI: 1619321908
Provider Name (Legal Business Name): APPLIED BEHAVIORAL INTERVENTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE A107
PHOENIX AZ
85051-9582
US

IV. Provider business mailing address

PO BOX 72657
PHOENIX AZ
85050-1028
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-2388
  • Fax: 800-881-7511
Mailing address:
  • Phone: 602-524-0824
  • Fax: 800-881-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-15037
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13418
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4010
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-10962
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSLG7643
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH4777
License Number StateAZ

VIII. Authorized Official

Name: VICTOR OKORIE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-441-2388