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NPI Code Detail

MEDICARE: BEHAVIOR GENIUS LLC

MEDICARE: BEHAVIOR GENIUS LLC
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1720626138
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEHAVIOR GENIUS LLC
Provider Business Mailing Address
First Line : 1500 S HAVEN AVE STE 250
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2973
Country : US
Telephone Number : 909-749-5204
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S HAVEN AVE STE 250
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2973
Country : US
Telephone Number : 909-749-5204
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR/OWNER
Name : PORTIA JAMES
Credential :
Telephone Number : 909-749-5204
Provider Enumeration Date : 12/16/2019
Last Update Date : 04/06/2023

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Directions to “BEHAVIOR GENIUS LLC ” Practice Location

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