Provider Demographics
NPI:1215479498
Name:STRIVE BEHAVIORAL INTERVENTION INC.
Entity type:Organization
Organization Name:STRIVE BEHAVIORAL INTERVENTION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DEVINE
Authorized Official - Last Name:WEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:717-781-3924
Mailing Address - Street 1:192 E LINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3532
Mailing Address - Country:US
Mailing Address - Phone:760-582-2005
Mailing Address - Fax:
Practice Address - Street 1:192 E LINE ST STE A
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3532
Practice Address - Country:US
Practice Address - Phone:760-582-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-05
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11415917103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty