Healthcare Provider Details

I. General information

NPI: 1417473257
Provider Name (Legal Business Name): STACY OLNEY BCBA 1-21-55585
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 E COOLEY DR STE 185
COLTON CA
92324-3983
US

IV. Provider business mailing address

8207 ARLINGTON AVE # 219
RIVERSIDE CA
92503-0429
US

V. Phone/Fax

Practice location:
  • Phone: 909-850-4651
  • Fax:
Mailing address:
  • Phone: 951-732-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-55585
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: