MEDICARE: SOUTHERN CALIFORNIA BEHAVIORAL COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-03-1090 BCBA	CA

General Provider Information

NPI Number	:	1366715484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CALIFORNIA BEHAVIORAL COUNSELING

Provider Business Mailing Address
First Line	:	1507 ANNADEL AVE
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2404
Country	:	US
Telephone Number	:	626-789-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 ANNADEL AVE
Second Line	:	TRUE
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2404
Country	:	US
Telephone Number	:	626-789-9400
Fax Number	:

Authorized Official
Title or Position	:	CEO/BCBA
Name	:	MR. GARY E. GEER
Credential	:	MA/BCBA
Telephone Number	:	626-789-9400

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	02/21/2012

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