Provider Demographics
NPI:1417592585
Name:HALLIGAN, RILEY COLE (BCBA)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:COLE
Last Name:HALLIGAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E DAKOTA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8472
Mailing Address - Country:US
Mailing Address - Phone:406-698-9714
Mailing Address - Fax:
Practice Address - Street 1:170 E DAKOTA AVE APT 3
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8472
Practice Address - Country:US
Practice Address - Phone:406-698-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1-23-67273103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst