Healthcare Provider Details

I. General information

NPI: 1578171153
Provider Name (Legal Business Name): ACORN AND OAK BEHAVIORAL AND EDUCATIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10228 9TH AVE S
SEATTLE WA
98168-1513
US

IV. Provider business mailing address

10228 9TH AVE S
SEATTLE WA
98168-1513
US

V. Phone/Fax

Practice location:
  • Phone: 206-249-9761
  • Fax:
Mailing address:
  • Phone: 323-243-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ANASTASIYA SHAPOVALOVA
Title or Position: CO-FOUNDER
Credential: MS, BCBA, LBA
Phone: 323-243-0413