Healthcare Provider Details

I. General information

NPI: 1780458570
Provider Name (Legal Business Name): STRIVE ABC A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N CLAREMONT BLVD STE 102B
CLAREMONT CA
91711-3583
US

IV. Provider business mailing address

1420 N CLAREMONT BLVD STE 102B
CLAREMONT CA
91711-3583
US

V. Phone/Fax

Practice location:
  • Phone: 626-209-9042
  • Fax:
Mailing address:
  • Phone: 626-209-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JESSICA MARIE LASCANO
Title or Position: CEO
Credential: BCBA
Phone: 626-209-9042