Provider Demographics
NPI:1841180700
Name:PEDIATRIC BEHAVIOR ASSOCIATES
Entity type:Organization
Organization Name:PEDIATRIC BEHAVIOR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSPER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:607-621-5676
Mailing Address - Street 1:627 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2866
Mailing Address - Country:US
Mailing Address - Phone:607-621-5676
Mailing Address - Fax:
Practice Address - Street 1:705 17TH ST STE 402
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3516
Practice Address - Country:US
Practice Address - Phone:843-338-0132
Practice Address - Fax:706-243-6459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty