Provider Demographics
NPI:1902558968
Name:INTEGRATIVE BEHAVIOR ANALYSIS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE BEHAVIOR ANALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSPER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:607-621-5676
Mailing Address - Street 1:194 AINSDALE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7821
Mailing Address - Country:US
Mailing Address - Phone:607-621-5676
Mailing Address - Fax:
Practice Address - Street 1:194 AINSDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7821
Practice Address - Country:US
Practice Address - Phone:607-621-5676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty