Healthcare Provider Details

I. General information

NPI: 1407572886
Provider Name (Legal Business Name): PILLAR 5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E 13TH ST
ARCATA CA
95521-6060
US

IV. Provider business mailing address

251 E 13TH ST
ARCATA CA
95521-6060
US

V. Phone/Fax

Practice location:
  • Phone: 707-601-7088
  • Fax: 707-781-4054
Mailing address:
  • Phone: 707-601-7088
  • Fax: 707-781-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS ANTHONY DECARLI
Title or Position: PRESIDENT/BCBA
Credential: BCBA
Phone: 707-601-7088