Provider Demographics
NPI:1871001719
Name:BROWN BEAR BEHAVIORAL CONSULTING
Entity Type:Organization
Organization Name:BROWN BEAR BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & BCBA
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:814-580-8260
Mailing Address - Street 1:PO BOX 80933
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-0933
Mailing Address - Country:US
Mailing Address - Phone:814-580-8260
Mailing Address - Fax:814-286-9120
Practice Address - Street 1:1806 COLVILLE STREET #6
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99775-0001
Practice Address - Country:US
Practice Address - Phone:814-580-8260
Practice Address - Fax:814-286-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty