Healthcare Provider Details

I. General information

NPI: 1407631625
Provider Name (Legal Business Name): JAMIE CAREY LEP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4695 MACARTHUR CT
NEWPORT BEACH CA
92660-1882
US

IV. Provider business mailing address

861 GLENCLIFF ST APT 83
LA HABRA CA
90631-6456
US

V. Phone/Fax

Practice location:
  • Phone: 949-490-2375
  • Fax:
Mailing address:
  • Phone: 702-423-1976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4362
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-11819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: