Healthcare Provider Details

I. General information

NPI: 1134054372
Provider Name (Legal Business Name): APPLIED BEHAVIOR ANALYSIS IN REAL LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 REDWOOD DRIVE
LA HONDA CA
94020-0332
US

IV. Provider business mailing address

PO BOX 332
LA HONDA CA
94020-0332
US

V. Phone/Fax

Practice location:
  • Phone: 650-799-4776
  • Fax:
Mailing address:
  • Phone: 650-799-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUANITA RENEE TRAVER STINE
Title or Position: MANAGING MEMBER
Credential: BCBA
Phone: 650-799-4776