Healthcare Provider Details

I. General information

NPI: 1245809995
Provider Name (Legal Business Name): QMR BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/19/2021
Certification Date: 06/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TOWN AND COUNTRY ROAD SUITE 1250 - #2146
ORANGE CA
92868
US

IV. Provider business mailing address

1100 TOWN AND COUNTRY ROAD SUITE 1250 - #2146
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 562-213-8578
  • Fax:
Mailing address:
  • Phone: 562-213-8578
  • 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 Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONICA DARLENE CUEN-RANDALL
Title or Position: CEO/ CLINICAL DIRECTOR
Credential: M.S., BCBA
Phone: 562-213-8578