Healthcare Provider Details

I. General information

NPI: 1891653713
Provider Name (Legal Business Name): BEHAVIOR LEAP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 INDIANA AVE STE 162
RIVERSIDE CA
92506-4221
US

IV. Provider business mailing address

21530 MILAM DR
RIVERSIDE CA
92507-0062
US

V. Phone/Fax

Practice location:
  • Phone: 951-452-0534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SAMEEN TAYYAB
Title or Position: OWNER
Credential: BCBA
Phone: 951-452-0534