Healthcare Provider Details

I. General information

NPI: 1487929964
Provider Name (Legal Business Name): BETTY TIA -CONGER MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 4TH ST STE 102
CLAREMONT CA
91711-4707
US

IV. Provider business mailing address

2209 E BASELINE RD STE 300-351
CLAREMONT CA
91711-7901
US

V. Phone/Fax

Practice location:
  • Phone: 213-507-1597
  • Fax:
Mailing address:
  • Phone: 213-507-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: