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General NPI Number Information
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NPI Number | 1487007969
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Entity Type | Organization
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Legal Business Name | PINNACLE BEHAVIOR SOLUTIONS, LLC.
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 125 INDIAN LOOKOUT DR
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City | LANDER
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State | WY
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Zip | 82520-3057
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Country | US
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Telephone | 307-438-1039
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Fax |
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Provider Business Mailing Address
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Address Line | 125 INDIAN LOOKOUT DR
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City | LANDER
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State | WY
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Zip | 82520-3057
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Country | US
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Telephone | 307-438-1039
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAYLOR JACOBS
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Credential | M.S., BCBA
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Telephone | 307-438-1039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | PTSB63527
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-15-19964
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License Number State | WY
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