Provider Demographics
NPI:1356821375
Name:BEHAVIORWAY, INC.
Entity Type:Organization
Organization Name:BEHAVIORWAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAKENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:720-660-2720
Mailing Address - Street 1:805 KINKEAD WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2636
Mailing Address - Country:US
Mailing Address - Phone:720-660-2720
Mailing Address - Fax:
Practice Address - Street 1:805 KINKEAD WAY APT 101
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2636
Practice Address - Country:US
Practice Address - Phone:720-660-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health