Healthcare Provider Details

I. General information

NPI: 1790237592
Provider Name (Legal Business Name): APPLIED BEHAVIORAL INTERVENTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 3RD AVE SUITE 220
YUMA AZ
85364-2224
US

IV. Provider business mailing address

200 S 3RD AVE SUITE 220
YUMA AZ
85364-2224
US

V. Phone/Fax

Practice location:
  • Phone: 928-919-1528
  • Fax:
Mailing address:
  • Phone: 928-919-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCSLG7866
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberCSLG7866
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberCSLG7866
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberCSLG7866
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-15037
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCSLG7866
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4010
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4605
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-10962
License Number StateAZ

VIII. Authorized Official

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