Healthcare Provider Details

I. General information

NPI: 1770066953
Provider Name (Legal Business Name): ERICA FERRELL CUYONG BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 MCGAW AVE
IRVINE CA
92614-5505
US

IV. Provider business mailing address

1063 MCGAW AVE
IRVINE CA
92614-5505
US

V. Phone/Fax

Practice location:
  • Phone: 714-679-3341
  • Fax:
Mailing address:
  • Phone: 714-679-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133532
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-29613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: