Provider Demographics
NPI:1639401375
Name:AUTISM BEHAVIOR CONSULTING GROUP, INC
Entity Type:Organization
Organization Name:AUTISM BEHAVIOR CONSULTING GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIECH
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:808-277-7736
Mailing Address - Street 1:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-1162
Mailing Address - Country:US
Mailing Address - Phone:808-637-7736
Mailing Address - Fax:808-748-0202
Practice Address - Street 1:66-434 KAMEHAMEHA HIGHWAY
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712
Practice Address - Country:US
Practice Address - Phone:808-277-7736
Practice Address - Fax:808-748-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1041581251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245426865OtherTRICARE