Provider Demographics
NPI:1336882422
Name:ENRICHED CHILDHOOD LEARNING & BEHAVIOR THERAPY LLC
Entity Type:Organization
Organization Name:ENRICHED CHILDHOOD LEARNING & BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSIP
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:239-603-9054
Mailing Address - Street 1:PO BOX 202774
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-8774
Mailing Address - Country:US
Mailing Address - Phone:239-603-9054
Mailing Address - Fax:
Practice Address - Street 1:9448 E FLORIDA AVE APT 2081
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-7827
Practice Address - Country:US
Practice Address - Phone:239-603-9054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty