Healthcare Provider Details

I. General information

NPI: 1841877842
Provider Name (Legal Business Name): BEHAVIORSPAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14707 E 2ND AVE # GL100
AURORA CO
80011-8965
US

IV. Provider business mailing address

14707 E 2ND AVE # GL100
AURORA CO
80011-8965
US

V. Phone/Fax

Practice location:
  • Phone: 720-717-9009
  • Fax: 720-815-0027
Mailing address:
  • Phone: 720-717-9009
  • Fax: 720-815-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. J JAMES TOMASH
Title or Position: CEO
Credential: PHD, BCBA-D
Phone: 720-717-9009