Healthcare Provider Details

I. General information

NPI: 1376408559
Provider Name (Legal Business Name): CORE ABILITIES BEHAVIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 FOOTHILLS RD APT G
LAKE OSWEGO OR
97034-3169
US

IV. Provider business mailing address

5002 FOOTHILLS RD APT G
LAKE OSWEGO OR
97034-3169
US

V. Phone/Fax

Practice location:
  • Phone: 209-217-2593
  • Fax:
Mailing address:
  • Phone: 209-217-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BRANDON ANTHONY MONTOYA
Title or Position: BEHAVIOR ANALYST
Credential: BCBA
Phone: 209-217-2593