Healthcare Provider Details

I. General information

NPI: 1629884960
Provider Name (Legal Business Name): LARK BEHAVIOR GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 RINALDI PL
PORTER RANCH CA
91326-2551
US

IV. Provider business mailing address

9722 PINE ORCHARD ST
PACOIMA CA
91331-6905
US

V. Phone/Fax

Practice location:
  • Phone: 818-916-0295
  • Fax: 818-724-7704
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN BOGHOSKHAN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 818-813-1803