Healthcare Provider Details

I. General information

NPI: 1013630359
Provider Name (Legal Business Name): CAIN BEHAVIORAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 STONERIDGE MALL RD STE 300
PLEASANTON CA
94588-3705
US

IV. Provider business mailing address

6200 STONERIDGE MALL RD STE 300 #1002
PLEASANTON CA
94588-3705
US

V. Phone/Fax

Practice location:
  • Phone: 888-773-4359
  • Fax:
Mailing address:
  • Phone: 888-773-4359
  • Fax: 855-507-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 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
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KE'AARRE CAIN
Title or Position: FOUNDER AND OWNER
Credential:
Phone: 888-773-4359