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General NPI Number Information
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NPI Number | 1467254037
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Entity Type | Organization
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Legal Business Name | PIVOTAL BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 5000 THAYER CTR STE C
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City | OAKLAND
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State | MD
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Zip | 21550-1139
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Country | US
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Telephone | 202-492-6575
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Fax | 737-587-0175
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Provider Business Mailing Address
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Address Line | 13704 THOMAS WHEELER WAY
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City | MANOR
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State | TX
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Zip | 78653-2685
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Country | US
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Telephone | 202-492-6575
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. BIDEMI BALOGUN
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Credential | MS, BCBA, LBA
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Telephone | 202-492-6575
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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 |
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