Provider Demographics
NPI:1285886101
Name:WOLF BEHAVIORAL CONSULTING
Entity type:Organization
Organization Name:WOLF BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:402-306-2333
Mailing Address - Street 1:12930 IZARD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1248
Mailing Address - Country:US
Mailing Address - Phone:402-306-2333
Mailing Address - Fax:610-300-2333
Practice Address - Street 1:12930 IZARD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1248
Practice Address - Country:US
Practice Address - Phone:402-306-2333
Practice Address - Fax:610-300-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1052476103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1052476OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD