Provider Demographics
NPI:1780924076
Name:HEART OF BEHAVIOR, LLC
Entity type:Organization
Organization Name:HEART OF BEHAVIOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:218-329-5609
Mailing Address - Street 1:1306 WESTPORT BEACH WAY
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8860
Mailing Address - Country:US
Mailing Address - Phone:218-329-5609
Mailing Address - Fax:
Practice Address - Street 1:1306 WESTPORT BEACH WAY
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8860
Practice Address - Country:US
Practice Address - Phone:218-329-5609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL8103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1-07-3910OtherBEHAVIOR ANALYST CERTIFICATION BOARD, INC