Provider Demographics
NPI:1770004228
Name:OVER THE RAINBOW BEHAVIORAL CONSULTING, LLC
Entity Type:Organization
Organization Name:OVER THE RAINBOW BEHAVIORAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOP
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:970-417-2096
Mailing Address - Street 1:3153 SILVER FOX DR
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-8463
Mailing Address - Country:US
Mailing Address - Phone:970-417-2096
Mailing Address - Fax:
Practice Address - Street 1:1010 S CASCADE AVE STE E
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4980
Practice Address - Country:US
Practice Address - Phone:970-417-2096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty