Healthcare Provider Details

I. General information

NPI: 1215890272
Provider Name (Legal Business Name): AVENUE BEAN ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41444 LILY AVE
MURRIETA CA
92562-2113
US

IV. Provider business mailing address

41444 LILY AVE
MURRIETA CA
92562-2113
US

V. Phone/Fax

Practice location:
  • Phone: 310-218-6488
  • Fax:
Mailing address:
  • Phone: 310-218-6488
  • 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: STEPHANIE L CHANEY
Title or Position: CEO
Credential:
Phone: 310-218-6488