Provider Demographics
NPI:1043712094
Name:FOUR DIRECTIONS EDUCATION AND BEHAVIOR CONSULTING LLC
Entity Type:Organization
Organization Name:FOUR DIRECTIONS EDUCATION AND BEHAVIOR CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:970-708-1217
Mailing Address - Street 1:PO BOX 3854
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-3854
Mailing Address - Country:US
Mailing Address - Phone:970-708-1217
Mailing Address - Fax:
Practice Address - Street 1:215 1/2 E COLORADO AVE 3A
Practice Address - Street 2:
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-8143
Practice Address - Country:US
Practice Address - Phone:970-708-1217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR DIRECTIONS EDUCATION AND BEHAVIOR CONSULTING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-17-25957103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty