Provider Demographics
NPI:1972995033
Name:BEHAVIORAL MOMENTUM LLC
Entity type:Organization
Organization Name:BEHAVIORAL MOMENTUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:334-796-0398
Mailing Address - Street 1:224 BELHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4041
Mailing Address - Country:US
Mailing Address - Phone:334-796-0398
Mailing Address - Fax:334-323-7979
Practice Address - Street 1:224 BELHAVEN DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4041
Practice Address - Country:US
Practice Address - Phone:334-796-0398
Practice Address - Fax:334-323-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29309103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty