Healthcare Provider Details

I. General information

NPI: 1881255412
Provider Name (Legal Business Name): 4 BEHAVIOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 S WESTERN AVE # A4
TORRANCE CA
90501-1307
US

IV. Provider business mailing address

20100 S WESTERN AVE # A4
TORRANCE CA
90501-1307
US

V. Phone/Fax

Practice location:
  • Phone: 800-701-6592
  • Fax:
Mailing address:
  • Phone: 310-971-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LORI BRUMMEL
Title or Position: PRESIDENT
Credential: BCBA, LEP
Phone: 310-971-4778