Provider Demographics
NPI:1568932804
Name:FAIRCLOUGH BEHAVIOR SERVICES LLC
Entity Type:Organization
Organization Name:FAIRCLOUGH BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:MR
Authorized Official - First Name:JAUN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FAIRCLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:770-608-7317
Mailing Address - Street 1:3852 MIRANDA CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8670
Mailing Address - Country:US
Mailing Address - Phone:770-608-7317
Mailing Address - Fax:
Practice Address - Street 1:3852 MIRANDA CT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8670
Practice Address - Country:US
Practice Address - Phone:770-608-7317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services