Lindsay Jackson

Individual provider Active NPI Behavior Technician · Davis, WV

NPI 1962005892 · NPPES record last updated Nov 22, 2020

Key facts

NPI
1962005892
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
1085 Canaan Heights Rd
Davis, WV 26260-8007
Phone
(304) 851-6643
NPI assigned
Nov 22, 2020
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Mountainside Behavior Analysis Services, LCC Past
since Nov 29, 2020
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

1085 Canaan Heights Rd
Davis, WV 26260-8007

Mailing address

1085 Canaan Heights Rd
Davis, WV 26260-8007
Phone (304) 851-6643

Other providers in Davis, WV

All providers in Davis, WV · Behavior Technician in West Virginia

Sources for this page

Verify at the official NPI Registry.