Healthcare Provider Details

I. General information

NPI: 1811262587
Provider Name (Legal Business Name): AUTISM AND BEHAVIOR CONCEPTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 FAIRLAWN AVE
LEXINGTON KY
40505-3224
US

IV. Provider business mailing address

PO BOX 1778
LEXINGTON KY
40588-1778
US

V. Phone/Fax

Practice location:
  • Phone: 859-797-2763
  • Fax:
Mailing address:
  • Phone: 859-797-2763
  • 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: MR. STEPHEN JOHN WOOD
Title or Position: LICENSED BEHAVIOR ANALYST
Credential: BCBA, LBA
Phone: 859-797-2763