Provider Demographics
NPI:1841565751
Name:BEHAVIOR INTERVENTION GROUP LLC
Entity Type:Organization
Organization Name:BEHAVIOR INTERVENTION GROUP LLC
Other - Org Name:BIG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FISHER POHLENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSC SLT BCBA
Authorized Official - Phone:918-630-0296
Mailing Address - Street 1:9832 S VANDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4805
Mailing Address - Country:US
Mailing Address - Phone:918-630-0296
Mailing Address - Fax:
Practice Address - Street 1:9832 S VANDALIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4805
Practice Address - Country:US
Practice Address - Phone:918-630-0296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency