Healthcare Provider Details

I. General information

NPI: 1821548645
Provider Name (Legal Business Name): AUSTIN FARRELL ROBERTS M.ED, BCBA, LABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20818 44TH AVE W STE 190
LYNNWOOD WA
98036-7745
US

IV. Provider business mailing address

23601 56TH AVE W UNIT 4104
MOUNTLAKE TERRACE WA
98043-5268
US

V. Phone/Fax

Practice location:
  • Phone: 425-673-6908
  • Fax:
Mailing address:
  • Phone: 425-275-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberAB61427616
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCG60703536
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: