Healthcare Provider Details

I. General information

NPI: 1982503256
Provider Name (Legal Business Name): SUBLIME BEHAVIOR SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3281 N WATERBROOK WAY
STAR ID
83669-6470
US

IV. Provider business mailing address

3281 N WATERBROOK WAY
STAR ID
83669-6470
US

V. Phone/Fax

Practice location:
  • Phone: 208-614-2063
  • Fax:
Mailing address:
  • Phone: 208-614-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA WORLEY
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: BCBA
Phone: 909-600-4350