Provider Demographics
NPI:1710447412
Name:ALLY BEHAVIOR LLC
Entity Type:Organization
Organization Name:ALLY BEHAVIOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-399-1786
Mailing Address - Street 1:108 W GREENWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4005
Mailing Address - Country:US
Mailing Address - Phone:703-399-1786
Mailing Address - Fax:
Practice Address - Street 1:108 W GREENWAY BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4005
Practice Address - Country:US
Practice Address - Phone:703-399-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty