Healthcare Provider Details

I. General information

NPI: 1205597457
Provider Name (Legal Business Name): AURORA BEHAVIORAL CONCEPTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 01/09/2022
Certification Date: 01/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 W BUXTON ST
RIALTO CA
92377-8833
US

IV. Provider business mailing address

1142 W BUXTON ST
RIALTO CA
92377-8833
US

V. Phone/Fax

Practice location:
  • Phone: 909-419-0967
  • Fax: 909-419-0967
Mailing address:
  • Phone: 909-419-0967
  • Fax: 909-419-0967

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

VIII. Authorized Official

Name: JULISSA L JOHNSON
Title or Position: CLINICAL DIRECTOR
Credential: BCBA
Phone: 909-419-0967