Provider Demographics
NPI:1073276945
Name:SR PLUS BEHAVIOR CONSULTANTS OF PACIFIC NORTHWEST
Entity Type:Organization
Organization Name:SR PLUS BEHAVIOR CONSULTANTS OF PACIFIC NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA BCBA
Authorized Official - Phone:910-840-5998
Mailing Address - Street 1:3715 NE HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9209
Mailing Address - Country:US
Mailing Address - Phone:303-880-3745
Mailing Address - Fax:
Practice Address - Street 1:3715 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9209
Practice Address - Country:US
Practice Address - Phone:303-880-3745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty