Provider Demographics
NPI:1295262426
Name:KRANSBERGER, CHARLES KODI
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KODI
Last Name:KRANSBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:543 18TH ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-6035
Mailing Address - Country:US
Mailing Address - Phone:608-921-9417
Mailing Address - Fax:
Practice Address - Street 1:6767 S SPRUCE ST STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6118
Practice Address - Country:US
Practice Address - Phone:303-225-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBACB375979106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COBACB375979OtherBEHAVIOR ANALYST CERTIFICATION BOARD