Healthcare Provider Details

I. General information

NPI: 1316353709
Provider Name (Legal Business Name): TUSTIN ABA SERVICES FOR KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 E 4TH ST
SANTA ANA CA
92705-3804
US

IV. Provider business mailing address

2201 E 4TH ST
SANTA ANA CA
92705-3804
US

V. Phone/Fax

Practice location:
  • Phone: 714-683-5876
  • Fax: 888-420-6257
Mailing address:
  • Phone: 714-683-5876
  • Fax: 888-420-6257

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
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DIANA KENNEY FUNK
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-422-3609