=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093584229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCHER BEHAVIOR SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2023
-----------------------------------------------------
Last Update Date | 12/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8074 S TRINCHERA PEAK
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-908-9097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8074 S TRINCHERA PEAK
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-908-9097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANGEL ARCHER
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 303-908-9097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------