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General NPI Number Information
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NPI Number | 1629326327
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Entity Type | Organization
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Legal Business Name | BLUE SKY BEHAVIOR ANALYSIS, LLC
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 2690 ED JONES RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-7973
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Country | US
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Telephone | 304-312-5374
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Fax | 703-594-4593
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Provider Business Mailing Address
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Address Line | 2690 ED JONES RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-7973
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Country | US
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Telephone | 304-312-5374
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Fax | 703-594-4593
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | RACHEL A CONNER
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Credential | M.S. ED., BCBA, NCC
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Telephone | 304-312-5374
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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 | 1-11-9500
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License Number State | VA
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