Provider Demographics
NPI:1710425798
Name:MR. BEHAVIOR LLC
Entity Type:Organization
Organization Name:MR. BEHAVIOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:916-390-8884
Mailing Address - Street 1:9433 W. 125TH ST.
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213
Mailing Address - Country:US
Mailing Address - Phone:916-390-8884
Mailing Address - Fax:913-213-5776
Practice Address - Street 1:9433 W 125TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-4732
Practice Address - Country:US
Practice Address - Phone:916-390-8884
Practice Address - Fax:913-213-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health