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General NPI Number Information
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NPI Number | 1790224988
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Entity Type | Organization
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Legal Business Name | BIG SKY BEHAVIORAL THERAPY, PLLC.
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 3170 TWO MOONS RD.
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City | BIG SKY
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State | MT
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Zip | 59716-0771
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Country | US
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Telephone | 914-391-9972
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 160771
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City | BIG SKY
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State | MT
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Zip | 59716-0771
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Country | US
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Telephone | 914-391-9972
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEANNE LIGHTBODY
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Credential | BCBA
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Telephone | 914-391-9972
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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 | 1-14-10041
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License Number State | CO
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