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General NPI Number Information
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NPI Number | 1104381623
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Entity Type | Organization
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Legal Business Name | INNOVATIVE BEHAVIOR ANALYSIS SUPPORT SYSTEMS, LLC
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 3 LORIAN CIR
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City | LITTLE ROCK
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State | AR
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Zip | 72212-2662
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Country | US
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Telephone | 501-570-6424
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Fax | 501-897-6407
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Provider Business Mailing Address
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Address Line | 3 LORIAN CIR
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City | LITTLE ROCK
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State | AR
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Zip | 72212-2662
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Country | US
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Telephone | 501-570-6424
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Fax | 501-897-6407
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Authorized Official
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Title or Position | OWNER/DIRECTOR OF CLINICAL SERVICES
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Name | CHRISTOPHER BOYD EWING
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Credential | BCBA
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Telephone | 501-570-6424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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