Healthcare Provider Details

I. General information

NPI: 1386329852
Provider Name (Legal Business Name): BEEHAVEN APPLIED BEHAVIORAL ANALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4729 W JENNIFER AVE
FRESNO CA
93722-6425
US

IV. Provider business mailing address

4729 W JENNIFER AVE
FRESNO CA
93722-6425
US

V. Phone/Fax

Practice location:
  • Phone: 559-696-2457
  • Fax:
Mailing address:
  • Phone: 559-696-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIANEY OBREGON
Title or Position: CHIEF FINANCE OFFICER
Credential:
Phone: 559-696-2457