Provider Demographics
NPI:1932512894
Name:PIVOTAL BEHAVIOR SOLUTIONS LLC
Entity Type:Organization
Organization Name:PIVOTAL BEHAVIOR SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APPLIED BEHAVIOR ANALYST/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BIRKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:719-310-3870
Mailing Address - Street 1:1575 PEREGRINE VISTA HTS
Mailing Address - Street 2:106
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4127
Mailing Address - Country:US
Mailing Address - Phone:719-310-3870
Mailing Address - Fax:888-843-4496
Practice Address - Street 1:1575 PEREGRINE VISTA HTS
Practice Address - Street 2:106
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-4127
Practice Address - Country:US
Practice Address - Phone:719-310-3870
Practice Address - Fax:888-843-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1118922103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty