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General NPI Number Information
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NPI Number | 1124532718
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Entity Type | Organization
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Legal Business Name | AUTISM BEHAVIORAL VENTURES LLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 8354 E NORTHFIELD BLVD STE 300
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City | DENVER
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State | CO
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Zip | 80238-3131
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Country | US
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Telephone | 720-961-3764
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 258831
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City | OKLAHOMA CITY
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State | OK
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Zip | 73125-8831
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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 | WILLIAM BOENIG
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Credential |
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Telephone | 408-802-4127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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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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