=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003504655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARKER BEHAVIOR THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2023
-----------------------------------------------------
Last Update Date | 05/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9371 W LA SALLE AVE
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-2964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-922-8857
-----------------------------------------------------
Fax | 303-845-9102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9371 W LA SALLE AVE
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-2964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-922-8857
-----------------------------------------------------
Fax | 303-845-9102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | TYLYN SHERIDAN
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 606-922-8857
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------