Provider Demographics
NPI:1295509602
Name:THE BEHAVIORAL EDGE LLC
Entity type:Organization
Organization Name:THE BEHAVIORAL EDGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BCBA OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSBCBA,LBA
Authorized Official - Phone:630-464-4363
Mailing Address - Street 1:1500 SMOKING TREE ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5718
Mailing Address - Country:US
Mailing Address - Phone:630-464-4363
Mailing Address - Fax:
Practice Address - Street 1:1500 SMOKING TREE ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5718
Practice Address - Country:US
Practice Address - Phone:630-464-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty