Healthcare Provider Details

I. General information

NPI: 1962372680
Provider Name (Legal Business Name): SOUTHERN OHIO APPLIED BEHAVIOR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 BIG RUN RD
PIKETON OH
45661-9669
US

IV. Provider business mailing address

931 BIG RUN RD
PIKETON OH
45661-9669
US

V. Phone/Fax

Practice location:
  • Phone: 616-821-0862
  • Fax: 616-821-0862
Mailing address:
  • Phone: 616-821-0862
  • Fax: 616-821-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID LEE HUTCHINS
Title or Position: DIRECTOR
Credential:
Phone: 616-821-0862