Healthcare Provider Details

I. General information

NPI: 1114223765
Provider Name (Legal Business Name): ADDISON BEHAVIORAL RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PASEO CAMARILLO STE 235
CAMARILLO CA
93010-0754
US

IV. Provider business mailing address

1000 PASEO CAMARILLO STE 235
CAMARILLO CA
93010-0754
US

V. Phone/Fax

Practice location:
  • Phone: 888-383-5566
  • Fax: 888-659-0031
Mailing address:
  • Phone: 888-383-5566
  • Fax: 888-659-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-05-2114
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 22059
License Number StateCA

VIII. Authorized Official

Name: DR. LAURA R. ADDISON
Title or Position: EXEC. DIRECTOR
Credential: PH.D, BCBA-D
Phone: 805-383-5566