Provider Demographics
NPI:1700471919
Name:SEA CHANGE BEHAVIOR ANALYSIS, LLC
Entity Type:Organization
Organization Name:SEA CHANGE BEHAVIOR ANALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BRIGITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:503-383-1776
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:NEOTSU
Mailing Address - State:OR
Mailing Address - Zip Code:97364
Mailing Address - Country:US
Mailing Address - Phone:503-383-1776
Mailing Address - Fax:
Practice Address - Street 1:4994 N US-101
Practice Address - Street 2:
Practice Address - City:NEOTSU
Practice Address - State:OR
Practice Address - Zip Code:97364
Practice Address - Country:US
Practice Address - Phone:541-204-0026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty