Healthcare Provider Details

I. General information

NPI: 1386182012
Provider Name (Legal Business Name): SOCIAL SKILLS FOR LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005B TORO CREEK RD
ATASCADERO CA
93422-1028
US

IV. Provider business mailing address

PO BOX 2157
ATASCADERO CA
93423-2157
US

V. Phone/Fax

Practice location:
  • Phone: 805-270-5347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ALEJANDRO URRUTIA JAUREGUI
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-270-5347