Healthcare Provider Details

I. General information

NPI: 1861850653
Provider Name (Legal Business Name): BEHAVIOR MANAGEMENT FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 E BELLEVUE RD
ATWATER CA
95301-2300
US

IV. Provider business mailing address

584 E BELLEVUE RD
ATWATER CA
95301-2300
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-2177
  • Fax:
Mailing address:
  • Phone: 559-747-2177
  • Fax: 559-751-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN PAUL NOWICKI
Title or Position: CEO/CLINICAL DIRECTOR
Credential: BCBA
Phone: 559-647-0004