Healthcare Provider Details

I. General information

NPI: 1619805991
Provider Name (Legal Business Name): BE THE CHANGE ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 CORPORATE DR STE R
JOHNSTON IA
50131-1659
US

IV. Provider business mailing address

20 LAKEFOREST TRL
SANFORD NC
27332-1046
US

V. Phone/Fax

Practice location:
  • Phone: 719-755-9072
  • Fax:
Mailing address:
  • Phone: 719-755-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE WISE
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 719-755-9072