Provider Demographics
NPI:1306298047
Name:ZIA ADVANCED BEHAVIOR ANALYTIC SERVICES P C
Entity type:Organization
Organization Name:ZIA ADVANCED BEHAVIOR ANALYTIC SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:RICHMOND
Authorized Official - Last Name:MANCIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:575-430-1823
Mailing Address - Street 1:117 SIERRA BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:TULAROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88352-2029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 SIERRA BLANCA AVE
Practice Address - Street 2:
Practice Address - City:TULAROSA
Practice Address - State:NM
Practice Address - Zip Code:88352-2029
Practice Address - Country:US
Practice Address - Phone:575-430-1823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services