Provider Demographics
NPI:1154611143
Name:AUTISM BEHAVIORAL CONSULTING
Entity type:Organization
Organization Name:AUTISM BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:360-524-3440
Mailing Address - Street 1:10000 NE 7TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4599
Mailing Address - Country:US
Mailing Address - Phone:360-524-3440
Mailing Address - Fax:360-989-3972
Practice Address - Street 1:10000 NE 7TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4599
Practice Address - Country:US
Practice Address - Phone:360-524-3440
Practice Address - Fax:360-989-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-07-3826OtherBOARD CERTIFIED BEHAVIOR ANALYST
WACL60158252OtherWASHINGTON STATE CERTIFIED COUNSELOR