Healthcare Provider Details

I. General information

NPI: 1528105582
Provider Name (Legal Business Name): BEHAVIOR MATTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 ELIZABETH ST
RIVERSIDE CA
92506-2506
US

IV. Provider business mailing address

2161 SAINT LAWRENCE STREET
RIVERSIDE CA
92504
US

V. Phone/Fax

Practice location:
  • Phone: 909-424-4654
  • Fax:
Mailing address:
  • Phone: 909-424-4654
  • Fax: 909-784-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS18030
License Number StateCA

VIII. Authorized Official

Name: MRS. MAVERNIE V. MITCHELL
Title or Position: PSYCHIATRIC SOCIAL WORKER
Credential: LCSW
Phone: 909-424-4654