NPIMap

Organization Active NPI

Pacific Northwest Behavior, LLC

  • Behavior Analyst
  • Spokane, WA
National Provider Identifier
1275020547
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
PACIFIC NORTHWEST BEHAVIOR, LLC
Practice address
1209 W 1St Ave
Spokane, WA 99201-4101
Phone
(509) 995-3388
Fax
(509) 321-4350
NPI assigned
Apr 22, 2018
Last updated
Oct 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Authorized official

Name
Ms. Kourtney Lea Kennedy, LBA, BCBANPI 1225409501
Title
Owner
Phone
(509) 995-3388

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 Analyst 103K00000X NU Primary

Addresses

Primary practice location

1209 W 1St Ave
Spokane, WA 99201-4101

Mailing address

1209 W 1St Ave
Spokane, WA 99201-4101
Phone (509) 995-3388

Other identifiers 1

IdentifierTypeStateIssuer
2100815MedicaidWA

National Provider Directory

National Provider Directory

Locations

1209 W 1st Ave
Spokane, WA 99201
Phone (509) 995-3388

227 W 3rd Ave
Spokane, WA 99201
Phone (509) 995-3388

Practitioners & affiliated clinicians

Practitioners 70

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.

View all 70

NPI Registry JSON

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

{
    "created_epoch": "1524355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1275020547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 W 1ST AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992014101",
            "telephone_number": "509-995-3388",
            "fax_number": "509-321-4350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 W 1ST AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992014101",
            "telephone_number": "509-995-3388",
            "fax_number": "509-321-4350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC NORTHWEST BEHAVIOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-22",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "KOURTNEY",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-995-3388",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LBA, BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2100815",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; 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.