Healthcare Provider Details

I. General information

NPI: 1396284451
Provider Name (Legal Business Name): KIMBERLY RETHANS M.S., M.ED., BCBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 EUCALYPTUS AVE
NEWMAN CA
95360-9502
US

IV. Provider business mailing address

661 EUCALYPTUS AVE
NEWMAN CA
95360-9502
US

V. Phone/Fax

Practice location:
  • Phone: 209-402-0427
  • Fax:
Mailing address:
  • Phone: 209-402-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-17418
License Number StateCA
# 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: KIMBERLY ANN RETHANS
Title or Position: CEO
Credential: M.S., M.ED., BCBA
Phone: 209-402-0427