Healthcare Provider Details

I. General information

NPI: 1174068464
Provider Name (Legal Business Name): MYBESTBEHAVIOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAIN ST STE 424
VANCOUVER WA
98660-2953
US

IV. Provider business mailing address

1220 MAIN ST STE 424
VANCOUVER WA
98660-2953
US

V. Phone/Fax

Practice location:
  • Phone: 360-751-5096
  • Fax:
Mailing address:
  • Phone: 360-751-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-17447
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberCL60641699
License Number StateWA

VIII. Authorized Official

Name: MOLLY ROGERS
Title or Position: ONSITE SUPERVISOR
Credential:
Phone: 360-751-5096