Healthcare Provider Details

I. General information

NPI: 1689188237
Provider Name (Legal Business Name): BEHAVIORAL DEVELOPMENTAL STRATEGIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17460 KRAMERIA AVE
RIVERSIDE CA
92504-6129
US

IV. Provider business mailing address

6809 INDIANA AVE
RIVERSIDE CA
92506-4221
US

V. Phone/Fax

Practice location:
  • Phone: 951-707-5665
  • Fax: 951-780-6268
Mailing address:
  • Phone: 951-707-5665
  • Fax: 951-776-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11518037
License Number StateCA

VIII. Authorized Official

Name: CHRISTOPHER HEROLD
Title or Position: OWNER
Credential: M.A., EDU
Phone: 951-707-5665