MEDICARE: ADVANCED BEHAVIORAL RESOURCES

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	:	1730846262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED BEHAVIORAL RESOURCES

Provider Business Mailing Address
First Line	:	PO BOX 18950
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-0950
Country	:	US
Telephone Number	:	720-771-0071
Fax Number	:	720-368-4580

Provider Business Practice Location Address
First Line	:	1313 N WILLIAMS ST APT 901
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2672
Country	:	US
Telephone Number	:	720-773-0071
Fax Number	:	720-368-4580

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	KEN WINN
Credential	:	BCBA
Telephone Number	:	720-773-0071

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	11/24/2021

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