NPIMap

Organization Active NPI

Behaviorlytics: a Social Change Agency

  • Behavior Analyst
  • Olympia, WA
National Provider Identifier
1194461798
Registry record updated May 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
BEHAVIORLYTICS: A SOCIAL CHANGE AGENCY
Doing business as
BehaviorLytics: A Social Change Agency
Practice address
905 Carlyon Ave SE
Olympia, WA 98501-3503
Phone
(360) 688-4231
NPI assigned
May 7, 2022
Last updated
May 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Holli Helen Henningsen Jerdes, BCBANPI 1114299203
Title
Executive Director
Phone
(360) 688-4231

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

905 Carlyon Ave SE
Olympia, WA 98501-3503

Mailing address

905 Carlyon Ave SE
Olympia, WA 98501-3503
Phone (360) 688-4231

Other names 1

  • BehaviorLytics: A Social Change Agency Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651881600000",
    "number": "1194461798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 CARLYON AVE SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985013503",
            "telephone_number": "360-688-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 CARLYON AVE SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985013503",
            "telephone_number": "360-688-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORLYTICS: A SOCIAL CHANGE AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-07",
        "last_updated": "2022-05-07",
        "certification_date": "2022-05-07",
        "status": "A",
        "authorized_official_last_name": "HENNINGSEN JERDES",
        "authorized_official_first_name": "HOLLI",
        "authorized_official_middle_name": "HELEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-688-4231",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BehaviorLytics: A Social Change Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.