Healthcare Provider Details

I. General information

NPI: 1134503709
Provider Name (Legal Business Name): BCBA CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22530 CANYON LAKE DR N
CANYON LAKE CA
92587-8001
US

IV. Provider business mailing address

22530 CANYON LAKE DR N
CANYON LAKE CA
92587-8001
US

V. Phone/Fax

Practice location:
  • Phone: 951-897-0137
  • Fax:
Mailing address:
  • Phone: 951-897-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-09-5791
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1-09-5791
License Number StateCO

VIII. Authorized Official

Name: MS. MARGARET A. MARILLA
Title or Position: PRESIDENT
Credential: M.A., BCBA
Phone: 951-897-0137