Healthcare Provider Details

I. General information

NPI: 1053888123
Provider Name (Legal Business Name): JASON CHURCH M.A., BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 HURLEY WAY STE 290
SACRAMENTO CA
95825-3221
US

IV. Provider business mailing address

2035 HURLEY WAY STE 290
SACRAMENTO CA
95825-3221
US

V. Phone/Fax

Practice location:
  • Phone: 916-272-1750
  • Fax:
Mailing address:
  • Phone: 916-272-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-63762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: