Provider Demographics
NPI:1487007969
Name:PINNACLE BEHAVIOR SOLUTIONS, LLC.
Entity Type:Organization
Organization Name:PINNACLE BEHAVIOR SOLUTIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:307-438-1039
Mailing Address - Street 1:125 INDIAN LOOKOUT DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3057
Mailing Address - Country:US
Mailing Address - Phone:307-438-1039
Mailing Address - Fax:
Practice Address - Street 1:125 INDIAN LOOKOUT DR
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3057
Practice Address - Country:US
Practice Address - Phone:307-438-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1-15-19964103K00000X
WYPTSB63527103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty