Provider Demographics
NPI:1720600661
Name:LINDER, RISLEY JR (BCBA)
Entity Type:Individual
Prefix:
First Name:RISLEY
Middle Name:
Last Name:LINDER
Suffix:JR
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5502
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-5502
Mailing Address - Country:US
Mailing Address - Phone:803-467-2996
Mailing Address - Fax:
Practice Address - Street 1:2003 GREENE ST APT 105
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1638
Practice Address - Country:US
Practice Address - Phone:803-467-2996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCWP8917103K00000X
1-17-26986103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWP8917Medicaid
1-17-26986OtherBEHAVIOR ANALYST CERTIFICATION BOARD