| Total Behavior Support | |
|
1015 S Broadway Ste 16 Minot ND 58701-4667 | |
| (707) 450-7587 | |
| Not Available |
| Full Name | Total Behavior Support |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1015 S Broadway Ste 16, Minot, North Dakota |
| Authorized Official Name and Position | Andrea Niccole Kornelis (BCBA) |
| Authorized Official Contact | 7074507587 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Total Behavior Support 1015 S Broadway Ste 16 Minot ND 58701-4667 Ph: (707) 450-7587 | Total Behavior Support 1015 S Broadway Ste 16 Minot ND 58701-4667 Ph: (707) 450-7587 |
| NPI Number | 1518541713 |
|---|---|
| Provider Enumeration Date | 05/12/2021 |
| Last Update Date | 07/19/2021 |
| Certification Date | 06/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518541713 | NPI | - | NPPES |
| L78 | Other | ND | BEHAVIOR ANALYST LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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