Healthcare Provider Details

I. General information

NPI: 1902058084
Provider Name (Legal Business Name): POSITIVE BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3393 SLY PARK RD
POLLOCK PINES CA
95726-9520
US

IV. Provider business mailing address

3393 SLY PARK RD
POLLOCK PINES CA
95726-9520
US

V. Phone/Fax

Practice location:
  • Phone: 530-644-4640
  • Fax: 530-644-5025
Mailing address:
  • Phone: 530-644-4640
  • Fax: 530-644-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-02-0785
License Number StateFL

VIII. Authorized Official

Name: JAMES HAMMAN
Title or Position: OWNER
Credential: BCBA
Phone: 530-644-4640