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General NPI Number Information
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NPI Number | 1124532288
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Entity Type | Organization
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Legal Business Name | BIG HORN BEHAVIOR CONSULTING
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 1408 BISMARK DR UNIT B
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City | POWELL
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State | WY
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Zip | 82435-9195
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Country | US
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Telephone | 307-271-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 BISMARK DR UNIT B
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City | POWELL
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State | WY
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Zip | 82435-9195
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARYBETH GUNDLACH
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Credential | BCBA
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Telephone | 307-271-0440
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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 | 1-16-23872
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License Number State | WY
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