Healthcare Provider Details

I. General information

NPI: 1437887189
Provider Name (Legal Business Name): BEACON BEHAVIOR CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17161 GRAY PINE PL
SAN BERNARDINO CA
92407-1504
US

IV. Provider business mailing address

17161 GRAY PINE PL
SAN BERNARDINO CA
92407-1504
US

V. Phone/Fax

Practice location:
  • Phone: 909-684-2987
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NINA DOLLENTE
Title or Position: CHIEF OPERATING OFFICER
Credential: BCBA
Phone: 909-684-2987