Healthcare Provider Details

I. General information

NPI: 1801141106
Provider Name (Legal Business Name): EAST BAY ABA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 CROW CANYON RD STE 101
SAN RAMON CA
94583-1659
US

IV. Provider business mailing address

2821 CROW CANYON RD STE 101
SAN RAMON CA
94583-1659
US

V. Phone/Fax

Practice location:
  • Phone: 510-999-4410
  • Fax: 877-565-6451
Mailing address:
  • Phone: 510-999-4410
  • Fax: 877-565-6451

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
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: LYNDA HOUNSHELL
Title or Position: OWNER/CEO
Credential: BCBA
Phone: 510-999-4410