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Organization
PROACTIVE BEHAVIOR THERAPY
Active
Organization
PROACTIVE BEHAVIOR THERAPY
Active
Other names
Proactive Behavior Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEAH CHRISTINE GONGOLA PH.D., BCBA-D, COBA (FOUNDER AND CEO)
(440) 313-8636
Entity
Organization
Contact information
Practice address
12573 CHILLICOTHE ROAD, CHESTERLAND, OH 44026
(440) 313-8636
(855) 960-0149
Mailing address
12573 CHILLICOTHE ROAD, CHESTERLAND, OH 44026
(440) 313-8636
(855) 960-0149
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0477305
—
OH
Enumeration date
07/14/2023
Last updated
07/14/2023
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