=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366638470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIORAL & ACADEMIC INTERVENTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4244 E WASHINGTON CT
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234-7791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-309-7522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4244 E WASHINGTON CT
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234-7791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-309-7522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRYAN DAVEY
-----------------------------------------------------
Credential | PHD, BCBA
-----------------------------------------------------
Telephone | 602-309-7522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 1-04-1491
-----------------------------------------------------
License Number State |
-----------------------------------------------------