Healthcare Provider Details

I. General information

NPI: 1518233949
Provider Name (Legal Business Name): AUTISM BEHAVIOR CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 OREGON CT STE A1
TORRANCE CA
90503-2693
US

IV. Provider business mailing address

2909 OREGON CT STE A1
TORRANCE CA
90503-2693
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-1333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LAURA ROBERTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-320-1333