Provider Demographics
NPI:1699910877
Name:BEHAVIORAL CONSULTATION SERVICES OF NORTHERN ARIZONA
Entity type:Organization
Organization Name:BEHAVIORAL CONSULTATION SERVICES OF NORTHERN ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:928-522-3780
Mailing Address - Street 1:906 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2986
Mailing Address - Country:US
Mailing Address - Phone:928-522-3780
Mailing Address - Fax:928-526-2119
Practice Address - Street 1:906 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2986
Practice Address - Country:US
Practice Address - Phone:928-522-3780
Practice Address - Fax:928-526-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency