Healthcare Provider Details

I. General information

NPI: 1811390081
Provider Name (Legal Business Name): ABA WORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 W OLYMPIC BLVD 250
LOS ANGELES CA
90064-1608
US

IV. Provider business mailing address

2633 LINCOLN BLVD 520
SANTA MONICA CA
90405
US

V. Phone/Fax

Practice location:
  • Phone: 310-456-4937
  • Fax: 888-286-8715
Mailing address:
  • Phone: 310-456-4937
  • Fax: 888-286-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMFC47309
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC47309
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11212499
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number11212499
License Number StateCA

VIII. Authorized Official

Name: MRS. WILLEMIJN JOHANNA CAMPBELL
Title or Position: CLINICAL DIRECTOR
Credential: BCBA, MFT
Phone: 310-456-4937