Provider Demographics
NPI:1447693023
Name:BEHAVIOR AND EDUCATION SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:BEHAVIOR AND EDUCATION SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:215-527-2124
Mailing Address - Street 1:4462 BUCK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-4182
Mailing Address - Country:US
Mailing Address - Phone:215-527-2124
Mailing Address - Fax:
Practice Address - Street 1:4462 BUCK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4182
Practice Address - Country:US
Practice Address - Phone:215-527-2124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8623103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty