Provider Demographics
NPI:1891554168
Name:AZULA BEHAVIORAL CONSULTING, LLC
Entity Type:Organization
Organization Name:AZULA BEHAVIORAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:970-235-1160
Mailing Address - Street 1:820 MEGAN UNIT A
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-4705
Mailing Address - Country:US
Mailing Address - Phone:970-235-1160
Mailing Address - Fax:970-808-2033
Practice Address - Street 1:820 MEGAN UNIT A
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-4705
Practice Address - Country:US
Practice Address - Phone:970-235-1160
Practice Address - Fax:970-808-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000190488Medicaid