Healthcare Provider Details

I. General information

NPI: 1407506884
Provider Name (Legal Business Name): ETHOS BEHAVIOR CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 MOCKINGBIRD CIR
WALDORF MD
20603-4632
US

IV. Provider business mailing address

4210 MOCKINGBIRD CIR
WALDORF MD
20603-4632
US

V. Phone/Fax

Practice location:
  • Phone: 202-868-3693
  • Fax:
Mailing address:
  • Phone: 202-868-3693
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA DANIELLE BRUCE
Title or Position: CLINICAL DIRECTOR
Credential: M.ED, BCBA, LBA
Phone: 202-868-3693