Provider Demographics
NPI:1801094560
Name:THE INSTITUTE FOR BEHAVIOR CHANGE
Entity type:Organization
Organization Name:THE INSTITUTE FOR BEHAVIOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:KOSSOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:610-383-9494
Mailing Address - Street 1:848 W KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1714
Mailing Address - Country:US
Mailing Address - Phone:610-383-9494
Mailing Address - Fax:610-383-9494
Practice Address - Street 1:848 W KINGS HWY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1714
Practice Address - Country:US
Practice Address - Phone:610-383-9494
Practice Address - Fax:610-383-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003680-L103TC2200X, 103TM1800X
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty