Provider Demographics
NPI:1003690850
Name:TEACHABAL MOMENTS BEHAVIOR THERAPY LLC
Entity Type:Organization
Organization Name:TEACHABAL MOMENTS BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:307-429-2047
Mailing Address - Street 1:61 INKBERRY RD
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-3733
Mailing Address - Country:US
Mailing Address - Phone:307-429-2047
Mailing Address - Fax:
Practice Address - Street 1:84 W BROADWAY STE 200
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2323
Practice Address - Country:US
Practice Address - Phone:307-429-2047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty