Provider Demographics
NPI:1417674763
Name:BLUE ROSE BEHAVIORAL CONSULTING
Entity Type:Organization
Organization Name:BLUE ROSE BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:253-466-6463
Mailing Address - Street 1:507 S 309TH CT
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4068
Mailing Address - Country:US
Mailing Address - Phone:253-466-6463
Mailing Address - Fax:888-255-7921
Practice Address - Street 1:507 S 309TH CT
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4068
Practice Address - Country:US
Practice Address - Phone:253-466-6463
Practice Address - Fax:888-255-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty