Provider Demographics
NPI:1134711393
Name:FUNCTIONAL BEHAVIOR INSTITUTE
Entity type:Organization
Organization Name:FUNCTIONAL BEHAVIOR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:307-575-2044
Mailing Address - Street 1:5248 PALM PINNACLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5682
Mailing Address - Country:US
Mailing Address - Phone:307-575-2044
Mailing Address - Fax:
Practice Address - Street 1:5248 PALM PINNACLE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-5682
Practice Address - Country:US
Practice Address - Phone:307-575-2044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty