Healthcare Provider Details

I. General information

NPI: 1740041482
Provider Name (Legal Business Name): WE BELONG BEHAVIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 RYLAN RD
MAHOMET IL
61853-4227
US

IV. Provider business mailing address

PO BOX 858
MAHOMET IL
61853-0858
US

V. Phone/Fax

Practice location:
  • Phone: 719-401-1706
  • Fax:
Mailing address:
  • Phone: 719-401-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: BRANDI ANNA-LIZA DANIELLE FISHER
Title or Position: PRESIDENT
Credential: BEHAVIOR ANALYST
Phone: 719-401-1706