Provider Demographics
NPI:1245609098
Name:CPB BEHAVIORAL THERAPY AND ADVOCACY SERVICES, LLC
Entity Type:Organization
Organization Name:CPB BEHAVIORAL THERAPY AND ADVOCACY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PETERSON BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:540-840-9285
Mailing Address - Street 1:1641 BELCHER MOUNTAIN RD.
Mailing Address - Street 2:
Mailing Address - City:MEADOWS OF DAN
Mailing Address - State:VA
Mailing Address - Zip Code:24120-3672
Mailing Address - Country:US
Mailing Address - Phone:540-840-9285
Mailing Address - Fax:540-242-0742
Practice Address - Street 1:1641 BELCHER MOUNTAIN RD.
Practice Address - Street 2:
Practice Address - City:MEADOWS OF DAN
Practice Address - State:VA
Practice Address - Zip Code:24120-3672
Practice Address - Country:US
Practice Address - Phone:540-840-9285
Practice Address - Fax:540-242-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA013300310103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty