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General NPI Number Information
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NPI Number | 1215601414
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Entity Type | Organization
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Legal Business Name | EDUCATION FOR THE EXTRAORDINARY INC.
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 12993 FROGTOWN CONNECTOR RD
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City | WALTON
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State | KY
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Zip | 41094-8447
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Country | US
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Telephone | 502-889-6259
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Fax |
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Provider Business Mailing Address
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Address Line | 12388 SHEPPARD WAY
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City | WALTON
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State | KY
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Zip | 41094-7839
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Country | US
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Telephone | 150-288-9625
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR AND LEAD BCBA
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Name | ASHLEY M HENDERSON
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Credential | M.ED., BCBA, LBA
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Telephone | 502-889-6259
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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 |
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License Number State |
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