Provider Demographics
NPI:1063627263
Name:APPLIED BEHAVIOR ALTERNATIVES
Entity type:Organization
Organization Name:APPLIED BEHAVIOR ALTERNATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:TUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-888-2350
Mailing Address - Street 1:1530 W STATE ST
Mailing Address - Street 2:STE F
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8503
Mailing Address - Country:US
Mailing Address - Phone:208-888-2350
Mailing Address - Fax:208-888-9309
Practice Address - Street 1:1530 W STATE ST
Practice Address - Street 2:STE F
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8503
Practice Address - Country:US
Practice Address - Phone:208-888-2350
Practice Address - Fax:208-888-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8072455251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8072454Medicaid
ID8072455Medicaid