Provider Demographics
NPI:1598279770
Name:APPLIED BEHAVIORAL INTERVENTIONS, PLLC
Entity Type:Organization
Organization Name:APPLIED BEHAVIORAL INTERVENTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OBIDIKE
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-524-0824
Mailing Address - Street 1:PO BOX 72657
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1028
Mailing Address - Country:US
Mailing Address - Phone:928-919-1528
Mailing Address - Fax:
Practice Address - Street 1:472 E WICKENBURG WAY STE 106
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1602
Practice Address - Country:US
Practice Address - Phone:928-919-1528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4725103TC0700X
251B00000X, 251S00000X, 261QM0801X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty