Healthcare Provider Details

I. General information

NPI: 1497492748
Provider Name (Legal Business Name): EDUCATIONAL AND BEHAVIORAL CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 CROSS RD
WEST CHESTERFIELD NH
03466-3209
US

IV. Provider business mailing address

86 CROSS RD
WEST CHESTERFIELD NH
03466-3209
US

V. Phone/Fax

Practice location:
  • Phone: 603-545-2671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NATHAN ANTAYA
Title or Position: BUSINESS MANAGER/CFO
Credential:
Phone: 603-256-6046