Healthcare Provider Details

I. General information

NPI: 1215894712
Provider Name (Legal Business Name): GENTLE BEHAVIOR RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3243 SAN CARLOS DR
SPRING VALLEY CA
91978-1059
US

IV. Provider business mailing address

3243 SAN CARLOS DR
SPRING VALLEY CA
91978-1059
US

V. Phone/Fax

Practice location:
  • Phone: 619-320-5235
  • Fax: 619-599-8055
Mailing address:
  • Phone: 619-320-5235
  • Fax: 619-599-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MARISSA AMAT-ROGERS
Title or Position: EXECUTIVE DIRECTOR
Credential: MA BCBA
Phone: 619-320-5235