Healthcare Provider Details

I. General information

NPI: 1245984939
Provider Name (Legal Business Name): BEHAVIOR ANALYTIC MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W WASHINGTON ST STE 4
SUFFOLK VA
23434-5320
US

IV. Provider business mailing address

425 W WASHINGTON ST STE 4
SUFFOLK VA
23434-5320
US

V. Phone/Fax

Practice location:
  • Phone: 757-974-0972
  • Fax: 757-974-9815
Mailing address:
  • Phone: 757-974-0972
  • Fax: 757-974-9815

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 Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BOWMAN
Title or Position: FOUNDER AND EXECUTIVE DIRECTOR
Credential: BCBA, LBA, IBA, CCTP
Phone: 757-974-0972