Healthcare Provider Details

I. General information

NPI: 1083050470
Provider Name (Legal Business Name): BEHAVIORAL DYNAMIC INTERVENTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 BRUNDAGE LN
BAKERSFIELD CA
93304-2848
US

IV. Provider business mailing address

1901 BRUNDAGE LN
BAKERSFIELD CA
93304-2848
US

V. Phone/Fax

Practice location:
  • Phone: 661-869-1074
  • Fax: 661-869-1075
Mailing address:
  • Phone: 661-869-1074
  • Fax: 661-869-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMFT39354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberMFT39354
License Number StateCA

VIII. Authorized Official

Name: MRS. ANA LAURA MAGANA
Title or Position: CLINICAL DIRECTOR
Credential: MS
Phone: 661-869-1074