Healthcare Provider Details

I. General information

NPI: 1073276945
Provider Name (Legal Business Name): SR PLUS BEHAVIOR CONSULTANTS OF PACIFIC NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 NE HIGHWAY 20
CORVALLIS OR
97330-9209
US

IV. Provider business mailing address

3715 NE HIGHWAY 20
CORVALLIS OR
97330-9209
US

V. Phone/Fax

Practice location:
  • Phone: 303-880-3745
  • Fax:
Mailing address:
  • Phone: 303-880-3745
  • 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 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: REBECCA CLICK
Title or Position: OWNER
Credential: MA. BCBA
Phone: 910-840-5998