Healthcare Provider Details

I. General information

NPI: 1487007969
Provider Name (Legal Business Name): PINNACLE BEHAVIOR SOLUTIONS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 INDIAN LOOKOUT DR
LANDER WY
82520-3057
US

IV. Provider business mailing address

125 INDIAN LOOKOUT DR
LANDER WY
82520-3057
US

V. Phone/Fax

Practice location:
  • Phone: 307-438-1039
  • Fax:
Mailing address:
  • Phone: 307-438-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19964
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPTSB63527
License Number StateWY

VIII. Authorized Official

Name: TAYLOR JACOBS
Title or Position: OWNER
Credential: M.S., BCBA
Phone: 307-438-1039