Healthcare Provider Details

I. General information

NPI: 1477989473
Provider Name (Legal Business Name): ASSOCIATION OF BEHAVIOR CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 B ST STE 1C
SANTA ROSA CA
95401-5269
US

IV. Provider business mailing address

PO BOX 1858
SEBASTOPOL CA
95473-1858
US

V. Phone/Fax

Practice location:
  • Phone: 707-583-1656
  • Fax:
Mailing address:
  • Phone: 707-583-1656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEVIN WINTER
Title or Position: CEO
Credential:
Phone: 707-583-1656