Healthcare Provider Details

I. General information

NPI: 1578013777
Provider Name (Legal Business Name): FLOURISH ABA BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 N BROADWAY SUITE 108
SANTA ANA CA
92706-2621
US

IV. Provider business mailing address

1912 N BROADWAY SUITE 108
SANTA ANA CA
92706-2641
US

V. Phone/Fax

Practice location:
  • Phone: 714-581-8660
  • Fax: 714-955-4397
Mailing address:
  • Phone: 714-581-8660
  • Fax: 714-955-4397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-14995
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name: JANICE BOTZBACH
Title or Position: DIRECTOR
Credential: MS, BCBA
Phone: 714-581-8660