Organization
APPLIED BEHAVIOR ALTERNATIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. COLLEEN MILLER TUCKETT (ADMINISTRATOR)
(208) 888-2350
Entity
Organization
Contact information
Practice address
1530 W STATE ST, STE F, MERIDIAN, ID 83642-8503
(208) 888-2350
(208) 888-9309
Mailing address
1530 W STATE ST, STE F, MERIDIAN, ID 83642-8503
(208) 888-2350
(208) 888-9309
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
8072455
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8072454
—
ID
05
—
8072455
—
ID
Enumeration date
05/11/2007
Last updated
08/22/2020
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