Healthcare Provider Details

I. General information

NPI: 1205386646
Provider Name (Legal Business Name): BEHAVIOR MATTERS CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WATERMAN BLVD STE 4A-208
FAIRFIELD CA
94534-1800
US

IV. Provider business mailing address

16941 N EAGLE RIVER LOOP RD STE 3
EAGLE RIVER AK
99577-7802
US

V. Phone/Fax

Practice location:
  • Phone: 907-726-5330
  • Fax: 907-726-5366
Mailing address:
  • Phone: 907-726-5330
  • Fax: 907-726-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: REBEKA EDGE
Title or Position: CEO
Credential: MA, BCBA, LBA
Phone: 907-726-5330