Provider Demographics
NPI:1962964205
Name:ODYSSEY BEHAVIOR COMPANY LLC
Entity type:Organization
Organization Name:ODYSSEY BEHAVIOR COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ZACHARY
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:805-328-8322
Mailing Address - Street 1:4515 LASATER TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1642
Mailing Address - Country:US
Mailing Address - Phone:805-328-8322
Mailing Address - Fax:
Practice Address - Street 1:4515 LASATER TRL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1642
Practice Address - Country:US
Practice Address - Phone:805-328-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty