Healthcare Provider Details

I. General information

NPI: 1710618020
Provider Name (Legal Business Name): AUTISM BEHAVIOR HEALTH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MCKINNON RD
BUCKSPORT ME
04416-4223
US

IV. Provider business mailing address

36 MCKINNON RD
BUCKSPORT ME
04416-4223
US

V. Phone/Fax

Practice location:
  • Phone: 207-814-8542
  • Fax: 207-261-1124
Mailing address:
  • Phone: 207-814-8542
  • Fax: 207-261-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE LEHMAN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 207-814-8542