Provider Demographics
NPI:1609572544
Name:COLORFUL MINDS BEHAVIOR SPECIALIST LLC
Entity Type:Organization
Organization Name:COLORFUL MINDS BEHAVIOR SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:334-249-3469
Mailing Address - Street 1:4043 RAY DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-2425
Mailing Address - Country:US
Mailing Address - Phone:334-249-3469
Mailing Address - Fax:
Practice Address - Street 1:4043 RAY DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-2425
Practice Address - Country:US
Practice Address - Phone:334-249-3469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty