Healthcare Provider Details

I. General information

NPI: 1326778648
Provider Name (Legal Business Name): BLUEPRINT BEHAVIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W BROADWAY APT 534
LONG BEACH CA
90802-5018
US

IV. Provider business mailing address

245 W BROADWAY APT 534
LONG BEACH CA
90802-5018
US

V. Phone/Fax

Practice location:
  • Phone: 323-868-6780
  • Fax:
Mailing address:
  • Phone: 323-868-6780
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITTENI MARIE COLBERT
Title or Position: OWNER
Credential: BCBA
Phone: 323-868-6780