Healthcare Provider Details

I. General information

NPI: 1851665400
Provider Name (Legal Business Name): BEAUTIFUL MINDS CENTER FOR AUTISM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 TAMPA AVE
RESEDA CA
91335-2467
US

IV. Provider business mailing address

7300 TAMPA AVE
RESEDA CA
91335-2467
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-1836
  • Fax:
Mailing address:
  • Phone: 310-247-1836
  • 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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. GABRIELLE IZRALSON
Title or Position: OWNER
Credential: BCBA
Phone: 310-247-1836