Provider Demographics
NPI:1760092852
Name:PROMOTING INDEPENDENCE BEHAVIORAL THERAPY LLC
Entity Type:Organization
Organization Name:PROMOTING INDEPENDENCE BEHAVIORAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:850-728-1853
Mailing Address - Street 1:316 TUXEDO DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6763
Mailing Address - Country:US
Mailing Address - Phone:850-728-1853
Mailing Address - Fax:833-252-3318
Practice Address - Street 1:316 TUXEDO DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6763
Practice Address - Country:US
Practice Address - Phone:850-728-1853
Practice Address - Fax:833-252-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty