Provider Demographics
NPI:1780276048
Name:MODERN BEHAVIOR CONSULTING LLC
Entity type:Organization
Organization Name:MODERN BEHAVIOR CONSULTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:815-308-2322
Mailing Address - Street 1:13550 S ROUTE 30
Mailing Address - Street 2:SUITE 204 # E
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544
Mailing Address - Country:US
Mailing Address - Phone:815-308-2322
Mailing Address - Fax:844-991-3532
Practice Address - Street 1:13550 S ROUTE 30
Practice Address - Street 2:SUITE 204 # E
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:815-308-2322
Practice Address - Fax:844-991-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1-15-20843OtherBEHAVIOR ANALYST CERTIFICATION BOARD