Provider Demographics
NPI:1497320493
Name:ACTUALIZE BEHAVIOR
Entity Type:Organization
Organization Name:ACTUALIZE BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EARNEST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-775-0151
Mailing Address - Street 1:9249 S BROADWAY STE 811
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5690
Mailing Address - Country:US
Mailing Address - Phone:720-775-0151
Mailing Address - Fax:
Practice Address - Street 1:5575 S SYCAMORE ST STE 108
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1141
Practice Address - Country:US
Practice Address - Phone:720-775-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09255346Medicaid