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General NPI Number Information
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NPI Number | 1073822656
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Entity Type | Organization
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Legal Business Name | APPLIED BEHAVIORAL INTERVENTION SERVICES, LLC
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 2028 HIGH POINT DR
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City | ALTOONA
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State | WI
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Zip | 54720-3506
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Country | US
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Telephone | 715-852-0112
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Fax | 715-852-0112
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Provider Business Mailing Address
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Address Line | 2028 HIGH POINT DR
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City | ALTOONA
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State | WI
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Zip | 54720-3506
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Country | US
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Telephone | 715-852-0112
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Fax | 715-852-0112
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Authorized Official
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Title or Position | MEMBER/LEAD THERAPIST
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Name | DR. KEVIN P KLATT
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Credential | PHD, BCBA-D, LBA
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Telephone | 715-852-0112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5-140
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License Number State | WI
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