Healthcare Provider Details

I. General information

NPI: 1336847433
Provider Name (Legal Business Name): JUSTIN MICHAEL CRAIG BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 CORONADO AVE
LONG BEACH CA
90804-2807
US

IV. Provider business mailing address

1342 CORONADO AVE
LONG BEACH CA
90804-2807
US

V. Phone/Fax

Practice location:
  • Phone: 562-766-1199
  • Fax:
Mailing address:
  • Phone: 562-766-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: