Healthcare Provider Details

I. General information

NPI: 1609468545
Provider Name (Legal Business Name): ANTECEDENT BEHAVIOR CONSEQUENCE & STRATEGIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13944 S ACADEMY AVE
KINGSBURG CA
93631-9207
US

IV. Provider business mailing address

13944 S ACADEMY AVE
KINGSBURG CA
93631-9207
US

V. Phone/Fax

Practice location:
  • Phone: 559-556-0030
  • Fax: 559-556-0030
Mailing address:
  • Phone: 559-556-0030
  • Fax: 559-556-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AZUCENA VERA
Title or Position: OFFICE MANAGER
Credential:
Phone: 559-556-0030