Healthcare Provider Details

I. General information

NPI: 1679400477
Provider Name (Legal Business Name): CABANA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BALA AVE APT 2
BALA CYNWYD PA
19004-3163
US

IV. Provider business mailing address

12 BALA AVE APT 2
BALA CYNWYD PA
19004-3163
US

V. Phone/Fax

Practice location:
  • Phone: 484-278-1025
  • Fax:
Mailing address:
  • Phone: 484-278-1025
  • 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: MR. DORIAN MITCHELL
Title or Position: CLINICAL DIRECTOR
Credential: MS, BCBA, LBS
Phone: 484-278-1025