Healthcare Provider Details

I. General information

NPI: 1417724378
Provider Name (Legal Business Name): BEHAVIOR IN ACTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 TEXAS ST FL 4
SAN DIEGO CA
92108-3725
US

IV. Provider business mailing address

PO BOX 19241
SAN DIEGO CA
92159-0241
US

V. Phone/Fax

Practice location:
  • Phone: 619-204-4442
  • Fax: 833-515-2618
Mailing address:
  • Phone: 619-733-9937
  • Fax: 833-515-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL HARRIS COE JR.
Title or Position: EXECUTIVE DIERECTOR
Credential: MBA
Phone: 619-204-4442