Healthcare Provider Details

I. General information

NPI: 1780918102
Provider Name (Legal Business Name): LAURA ADDISON DBA ADDISON BEHAVIORAL RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MOBIL AVE SUITE 209
CAMARILLO CA
93010-6328
US

IV. Provider business mailing address

266 MOBIL AVE SUITE 209
CAMARILLO CA
93010-6328
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-5566
  • Fax: 888-659-0031
Mailing address:
  • Phone: 805-383-5566
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberPSY 22059
License Number StateCA

VIII. Authorized Official

Name: DR. LAURA R. ADDISON
Title or Position: CEO
Credential: PHD, BCBA
Phone: 805-383-5566