Healthcare Provider Details

I. General information

NPI: 1205235751
Provider Name (Legal Business Name): DENISE JAMES BCBA, COBA, LBS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 WINDHAM CT STE 4
BOARDMAN OH
44512-5083
US

IV. Provider business mailing address

950 WINDHAM CT STE 4
BOARDMAN OH
44512-5083
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-2955
  • Fax: 330-629-2956
Mailing address:
  • Phone: 330-629-2955
  • Fax: 330-629-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007731
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16720
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.56
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: