Healthcare Provider Details

I. General information

NPI: 1043047814
Provider Name (Legal Business Name): MINDLINQ BEHAVIOR SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7849 SAINT CLAIR AVE
NORTH HOLLYWOOD CA
91605-2313
US

IV. Provider business mailing address

7849 SAINT CLAIR AVE
NORTH HOLLYWOOD CA
91605-2313
US

V. Phone/Fax

Practice location:
  • Phone: 818-601-7676
  • Fax:
Mailing address:
  • Phone: 818-601-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SEVAK POLATIAN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 818-601-7676