Healthcare Provider Details

I. General information

NPI: 1649928904
Provider Name (Legal Business Name): ACORN BEHAVIOR SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6042 EASTBROOK AVE
LAKEWOOD CA
90713-1053
US

IV. Provider business mailing address

6042 EASTBROOK AVE
LAKEWOOD CA
90713-1053
US

V. Phone/Fax

Practice location:
  • Phone: 310-987-6821
  • Fax:
Mailing address:
  • Phone: 310-987-6821
  • Fax:

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: PHUONG LUONG
Title or Position: MANAGER
Credential:
Phone: 310-987-6821