Provider Demographics
NPI:1538459151
Name:ACTIVE LEARNERS BEHAVIORAL CONSULTING, LLC
Entity Type:Organization
Organization Name:ACTIVE LEARNERS BEHAVIORAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:LORAY
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:405-808-3946
Mailing Address - Street 1:2613 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7603
Mailing Address - Country:US
Mailing Address - Phone:405-808-3946
Mailing Address - Fax:405-285-6681
Practice Address - Street 1:301 S BOULEVARD STE 126
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3880
Practice Address - Country:US
Practice Address - Phone:405-808-3946
Practice Address - Fax:405-285-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-10-7508103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty