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General NPI Number Information
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NPI Number | 1811262587
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Entity Type | Organization
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Legal Business Name | AUTISM AND BEHAVIOR CONCEPTS LLC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 128 FAIRLAWN AVE
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City | LEXINGTON
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State | KY
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Zip | 40505-3224
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Country | US
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Telephone | 859-797-2763
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1778
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City | LEXINGTON
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State | KY
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Zip | 40588-1778
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Country | US
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Telephone | 859-797-2763
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Fax |
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Authorized Official
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Title or Position | LICENSED BEHAVIOR ANALYST
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Name | MR. STEPHEN JOHN WOOD
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Credential | BCBA, LBA
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Telephone | 859-797-2763
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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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