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General NPI Number Information
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NPI Number | 1679400477
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Entity Type | Organization
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Legal Business Name | CABANA BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 12 BALA AVE APT 2
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City | BALA CYNWYD
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State | PA
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Zip | 19004-3163
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Country | US
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Telephone | 484-278-1025
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Fax |
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Provider Business Mailing Address
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Address Line | 12 BALA AVE APT 2
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City | BALA CYNWYD
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State | PA
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Zip | 19004-3163
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Country | US
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Telephone | 484-278-1025
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. DORIAN MITCHELL
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Credential | MS, BCBA, LBS
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Telephone | 484-278-1025
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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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