=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881152197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLIED BEHAVIOR CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2019
-----------------------------------------------------
Last Update Date | 03/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6122 AVENUE H
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35020-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-788-1121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6122 AVENUE H
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35020-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-788-1121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | KATHRYN JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-788-1121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------