=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457745374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIOR THERAPY INTERNATIONAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2015
-----------------------------------------------------
Last Update Date | 04/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 N 2ND ST
-----------------------------------------------------
City | WORMLEYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17043-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-588-4222
-----------------------------------------------------
Fax | 717-775-3443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 N 2ND ST
-----------------------------------------------------
City | WORMLEYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17043-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-588-4222
-----------------------------------------------------
Fax | 717-775-3443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. PAUL ESCHBACH
-----------------------------------------------------
Credential | MA BCBA
-----------------------------------------------------
Telephone | 717-802-1732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | BH002564
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------