Provider Demographics
NPI:1184142929
Name:BUCKEYE BEHAVIOR SERVICES, LLC.
Entity type:Organization
Organization Name:BUCKEYE BEHAVIOR SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LACY
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D, COBA, PHD
Authorized Official - Phone:937-750-1054
Mailing Address - Street 1:5388 WEIDNER RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-7710
Mailing Address - Country:US
Mailing Address - Phone:937-750-1054
Mailing Address - Fax:
Practice Address - Street 1:3333 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2765
Practice Address - Country:US
Practice Address - Phone:937-750-1054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.320103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1003351826Medicaid