| Powder River Behavior Consultation, Llc | |
|
812 Glacier St Gillette WY 82718-5752 | |
| (949) 922-3043 | |
| Not Available |
| Full Name | Powder River Behavior Consultation, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 812 Glacier St, Gillette, Wyoming |
| Authorized Official Name and Position | Kristina Marie Leslie (OWNER) |
| Authorized Official Contact | 9499223043 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Powder River Behavior Consultation, Llc 812 Glacier St Gillette WY 82718-5752 Ph: (949) 922-3043 | Powder River Behavior Consultation, Llc 812 Glacier St Gillette WY 82718-5752 Ph: (949) 922-3043 |
| NPI Number | 1336526979 |
|---|---|
| Provider Enumeration Date | 05/04/2015 |
| Last Update Date | 05/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336526979 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-13-13894 (Colorado) | Primary |
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