Healthcare Provider Details

I. General information

NPI: 1649184441
Provider Name (Legal Business Name): ABC BEHAVIORAL CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 OLD NEWPORT BLVD STE 102
NEWPORT BEACH CA
92663-4232
US

IV. Provider business mailing address

471 OLD NEWPORT BLVD STE 102
NEWPORT BEACH CA
92663-4232
US

V. Phone/Fax

Practice location:
  • Phone: 747-221-3496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDY KECHEJIAN
Title or Position: CEO
Credential:
Phone: 747-221-3496