Provider Demographics
NPI:1356153878
Name:BEHAVIOR REHAB
Entity type:Organization
Organization Name:BEHAVIOR REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KILLAM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:217-827-4755
Mailing Address - Street 1:20650 TIMBERED ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-3949
Mailing Address - Country:US
Mailing Address - Phone:217-827-4755
Mailing Address - Fax:
Practice Address - Street 1:20650 TIMBERED ESTATES LN
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-3949
Practice Address - Country:US
Practice Address - Phone:217-827-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty