Provider Demographics
NPI:1417504135
Name:THE CENTERS FOR BEHAVIOR INTERVENTION
Entity Type:Organization
Organization Name:THE CENTERS FOR BEHAVIOR INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:HOLLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-252-7792
Mailing Address - Street 1:4413 PROGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6709 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-3943
Practice Address - Country:US
Practice Address - Phone:708-995-5751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty