Provider Demographics
NPI:1578872859
Name:AGAR, GRAYDON L (BCBA)
Entity Type:Individual
Prefix:
First Name:GRAYDON
Middle Name:L
Last Name:AGAR
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 VIRGINIA ST
Mailing Address - Street 2:UNIT 1603
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-4421
Mailing Address - Country:US
Mailing Address - Phone:206-618-4673
Mailing Address - Fax:
Practice Address - Street 1:819 VIRGINIA ST
Practice Address - Street 2:UNIT 1603
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-4421
Practice Address - Country:US
Practice Address - Phone:206-618-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-03-1189103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst