Healthcare Provider Details

I. General information

NPI: 1164836466
Provider Name (Legal Business Name): CROWN BEHAVIOR SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 CHESTER ST
FRONT ROYAL VA
22630-3367
US

IV. Provider business mailing address

44 CHESTER ST
FRONT ROYAL VA
22630-3367
US

V. Phone/Fax

Practice location:
  • Phone: 540-717-3591
  • Fax: 855-258-4022
Mailing address:
  • Phone: 540-717-3591
  • Fax: 855-258-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000197
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004264
License Number StateVA

VIII. Authorized Official

Name: DR. SHERRI M YODER
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD
Phone: 540-717-3591