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NPI Code Detail

MEDICARE: MORNING STAR ABA THERAPY LLC

MEDICARE: MORNING STAR ABA THERAPY 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
1103K00000XBehavior Analyst1-13-14639CA

General Provider Information

NPI Number : 1750770350
Entity Type Code : Organization
Provider Name (Legal Business Name) : MORNING STAR ABA THERAPY LLC
Provider Business Mailing Address
First Line : 32565 GOLDEN LANTERN # B180
Second Line :
City : DANA POINT
State : CA
Zip : 92629-3247
Country : US
Telephone Number : 714-552-1317
Fax Number :
Provider Business Practice Location Address
First Line : 32565 GOLDEN LANTERN # B180
Second Line :
City : DANA POINT
State : CA
Zip : 92629-3247
Country : US
Telephone Number : 714-552-1317
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MRS. AMANDA DISSMORE
Credential : M.A., BCBA
Telephone Number : 714-552-1317
Provider Enumeration Date : 01/20/2015
Last Update Date : 06/04/2025

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Directions to “MORNING STAR ABA THERAPY LLC ” Practice Location

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