Healthcare Provider Details

I. General information

NPI: 1427598671
Provider Name (Legal Business Name): ADVANCE BEHAVIORAL THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1987 BONIFACIO ST
CONCORD CA
94520-2189
US

IV. Provider business mailing address

PO BOX 393
CONCORD CA
94522-0393
US

V. Phone/Fax

Practice location:
  • Phone: 925-640-1220
  • Fax: 925-522-5234
Mailing address:
  • Phone: 925-640-1220
  • Fax: 925-522-5234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7381
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name: JILLIAN NICHOLE DURGEN
Title or Position: CEO
Credential: M.ED., BCBA
Phone: 925-640-1220