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NPI Code Detail

MEDICARE: EXTRAORDINARY OPTIONS

MEDICARE: EXTRAORDINARY OPTIONS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2103K00000XBehavior AnalystCA

General Provider Information

NPI Number : 1437398542
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXTRAORDINARY OPTIONS
Provider Business Mailing Address
First Line : 10736 JEFFERSON BLVD.
Second Line : 262
City : CULVER CITY
State : CA
Zip : 90230
Country : US
Telephone Number : 310-721-2411
Fax Number :
Provider Business Practice Location Address
First Line : 1776 E CENTURY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90002-3050
Country : US
Telephone Number : 310-721-2411
Fax Number :
Authorized Official
Title or Position : CHAIRMAN
Name : ANDREA BROWN
Credential :
Telephone Number : 310-721-2411
Provider Enumeration Date : 02/12/2009
Last Update Date : 02/12/2009

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Directions to “EXTRAORDINARY OPTIONS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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