Provider Demographics
NPI:1245987346
Name:POSITIVE BEHAVIORAL SERVICES OF THE FOUR CORNERS LLC
Entity type:Organization
Organization Name:POSITIVE BEHAVIORAL SERVICES OF THE FOUR CORNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-946-1539
Mailing Address - Street 1:PO BOX 76510
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80970-6510
Mailing Address - Country:US
Mailing Address - Phone:970-946-1539
Mailing Address - Fax:719-638-8115
Practice Address - Street 1:23 S BEECH ST STE B102
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3751
Practice Address - Country:US
Practice Address - Phone:970-946-1539
Practice Address - Fax:719-638-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health