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General NPI Number Information
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NPI Number | 1336650399
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Entity Type | Organization
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Legal Business Name | FRONT RANGE BEHAVIORAL ASSOCIATES
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 6725 E 8TH AVE
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City | DENVER
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State | CO
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Zip | 80220-4705
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Country | US
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Telephone | 610-513-0161
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Fax |
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Provider Business Mailing Address
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Address Line | 6725 E 8TH AVE
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City | DENVER
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State | CO
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Zip | 80220-4705
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Country | US
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Telephone | 610-513-0161
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MICHELLE LYNN MCDERMOTT
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Credential | M.S.ED BCBA
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Telephone | 610-513-0161
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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 |
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License Number State | CO
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