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General NPI Number Information
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NPI Number | 1124455142
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Entity Type | Organization
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Legal Business Name | SEATTLE BEHAVIOR CONSULTING & THERAPY, LLC
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 4746 11TH AVE NE SUITE 102
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City | SEATTLE
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State | WA
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Zip | 98105-4657
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Country | US
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Telephone | 206-535-8876
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Fax | 206-486-9938
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Provider Business Mailing Address
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Address Line | 4746 11TH AVE NE SUITE 102
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City | SEATTLE
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State | WA
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Zip | 98105-4657
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Country | US
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Telephone | 206-535-8876
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Fax | 206-486-9938
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Authorized Official
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Title or Position | OWNER/BEHAVIOR ANALYST
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Name | DR. MARA KATRA OBLAK
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Credential | PHD, BCBA-D
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Telephone | 206-535-8876
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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 | 1-09-5509
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License Number State |
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Taxonomy #2
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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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