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General NPI Number Information
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NPI Number | 1538459151
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Entity Type | Organization
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Legal Business Name | ACTIVE LEARNERS BEHAVIORAL CONSULTING, LLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 301 S BOULEVARD STE 126
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City | EDMOND
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State | OK
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Zip | 73034-3880
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Country | US
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Telephone | 405-808-3946
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Fax | 405-285-6681
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Provider Business Mailing Address
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Address Line | 2613 NW 30TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7603
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Country | US
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Telephone | 405-808-3946
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Fax | 405-285-6681
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | JEANNA LORAY MILTON
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Credential | M.ED, BCBA
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Telephone | 405-808-3946
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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 | 1-10-7508
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License Number State | OK
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