Provider Demographics
NPI:1861936767
Name:MOMENTUM BEHAVIORAL SOLUTIONS
Entity type:Organization
Organization Name:MOMENTUM BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, NCSP
Authorized Official - Phone:405-693-5675
Mailing Address - Street 1:2449 NW 198TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-5236
Mailing Address - Country:US
Mailing Address - Phone:405-693-5675
Mailing Address - Fax:
Practice Address - Street 1:2449 NW 198TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-5236
Practice Address - Country:US
Practice Address - Phone:405-693-5675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty