Provider Demographics
NPI:1477040244
Name:LIVE OAK BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:LIVE OAK BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:706-755-2785
Mailing Address - Street 1:PO BOX 1997
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-1997
Mailing Address - Country:US
Mailing Address - Phone:706-755-2785
Mailing Address - Fax:706-755-2783
Practice Address - Street 1:1135 WALTONS PASS
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8250
Practice Address - Country:US
Practice Address - Phone:706-755-2785
Practice Address - Fax:206-755-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty