MEDICARE: A VILLAGE BEHAVIOR SERVICES 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	:	1598466658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A VILLAGE BEHAVIOR SERVICES LLC

Provider Business Mailing Address
First Line	:	2510 WESTMONT WAY W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3720
Country	:	US
Telephone Number	:	206-604-3214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 WESTMONT WAY W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3720
Country	:	US
Telephone Number	:	206-604-3214
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	AUBREE ANNE MALCOMB
Credential	:	M.ED., BCBA, LBA
Telephone Number	:	206-604-3214

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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