Provider Demographics
NPI:1790090744
Name:INTERACTIVE BEHAVIOR THERAPY LLC
Entity Type:Organization
Organization Name:INTERACTIVE BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ALTIZER
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, BCBA
Authorized Official - Phone:720-870-3071
Mailing Address - Street 1:6945 S NETHERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2602
Mailing Address - Country:US
Mailing Address - Phone:720-870-3071
Mailing Address - Fax:
Practice Address - Street 1:6945 S NETHERLAND WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-2602
Practice Address - Country:US
Practice Address - Phone:720-870-3071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-10-7180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty