MEDICARE: LEAD BEHAVIORAL THERAPY CO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1073469060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAD BEHAVIORAL THERAPY CO LLC

Provider Business Mailing Address
First Line	:	1500 N GRANT ST STE N
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N GRANT ST STE N
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	710-689-9991
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	ELIYAHU SAMEN
Credential	:
Telephone Number	:	720-689-9991

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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