=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194491571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESSENTIAL BEHAVIOR INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2021
-----------------------------------------------------
Last Update Date | 11/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 WAKEFIELD ST
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42103-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-935-5119
-----------------------------------------------------
Fax | 270-935-5109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 WAKEFIELD ST
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42103-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-935-5119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. CARRIE L PRITCHARD
-----------------------------------------------------
Credential | PHD., BCBA, LBA
-----------------------------------------------------
Telephone | 270-303-2098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------