Provider Demographics
NPI:1598289951
Name:A BEHAVIORAL HEALTH COOPERATIVE, L.L.C.
Entity Type:Organization
Organization Name:A BEHAVIORAL HEALTH COOPERATIVE, L.L.C.
Other - Org Name:THE ABC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-862-2250
Mailing Address - Street 1:32663 BUSH GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9751
Mailing Address - Country:US
Mailing Address - Phone:503-388-0230
Mailing Address - Fax:503-296-5396
Practice Address - Street 1:32663 BUSH GARDEN DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-9751
Practice Address - Country:US
Practice Address - Phone:503-780-0292
Practice Address - Fax:503-296-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty