Healthcare Provider Details

I. General information

NPI: 1558297630
Provider Name (Legal Business Name): BRIGHT PATH ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 CORBIN AVE STE 115
TARZANA CA
91356-2914
US

IV. Provider business mailing address

5530 CORBIN AVE STE 115
TARZANA CA
91356-2914
US

V. Phone/Fax

Practice location:
  • Phone: 310-908-0000
  • Fax: 213-693-1162
Mailing address:
  • Phone: 310-908-0000
  • Fax: 213-693-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIM MITCHELL POTTER
Title or Position: BILLING CONSULTANT
Credential: BCBA LBA LBS
Phone: 201-978-3815