Provider Demographics
NPI:1083334221
Name:BEHAVIOR CLUB
Entity Type:Organization
Organization Name:BEHAVIOR CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMANA
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, BCBA
Authorized Official - Phone:208-907-4038
Mailing Address - Street 1:4961 ANDERSON WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8477
Mailing Address - Country:US
Mailing Address - Phone:831-245-6291
Mailing Address - Fax:208-992-0246
Practice Address - Street 1:4961 ANDERSON WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-8477
Practice Address - Country:US
Practice Address - Phone:208-907-4038
Practice Address - Fax:208-992-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty