Provider Demographics
NPI:1558763912
Name:PRAXIS BEHAVIORAL CONSULTING
Entity Type:Organization
Organization Name:PRAXIS BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:310-940-8853
Mailing Address - Street 1:1331 BOLLING AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1301
Mailing Address - Country:US
Mailing Address - Phone:310-940-8853
Mailing Address - Fax:804-684-5112
Practice Address - Street 1:1331 BOLLING AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-1301
Practice Address - Country:US
Practice Address - Phone:310-940-8853
Practice Address - Fax:804-684-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000146103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty