Healthcare Provider Details

I. General information

NPI: 1932752375
Provider Name (Legal Business Name): PREPARING INDIVIDUALS TODAY FOR TOMORROW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4443 CIRCLE DR
BETHLEHEM PA
18020-9607
US

IV. Provider business mailing address

PO BOX 20503
LEHIGH VALLEY PA
18002-0503
US

V. Phone/Fax

Practice location:
  • Phone: 484-335-6100
  • Fax:
Mailing address:
  • Phone: 484-335-6100
  • Fax: 484-335-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SADIQ LOCUS
Title or Position: CLINICAL SERVICE EXECUTIVE
Credential: MS, BCBA, LBS
Phone: 484-335-6100