Provider Demographics
NPI:1467254037
Name:PIVOTAL BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:PIVOTAL BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BIDEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:202-492-6575
Mailing Address - Street 1:13704 THOMAS WHEELER WAY
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-2685
Mailing Address - Country:US
Mailing Address - Phone:202-492-6575
Mailing Address - Fax:
Practice Address - Street 1:5511 PARKCREST DR STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4917
Practice Address - Country:US
Practice Address - Phone:443-720-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty