=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760147953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPEN DOOR BEHAVIOR SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2021
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19821 MARGARET CT
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60411-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-374-0747
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3445 JENNIFER CT
-----------------------------------------------------
City | STEGER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60475-1528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-374-0747
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MAYA WILLIAMS
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 708-374-0747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------