Healthcare Provider Details

I. General information

NPI: 1427918259
Provider Name (Legal Business Name): LIGHTPATH BEHAVIORAL SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N TUSTIN AVE STE E4
TUSTIN CA
92780-2971
US

IV. Provider business mailing address

151 N TUSTIN AVE STE E4
TUSTIN CA
92780-2971
US

V. Phone/Fax

Practice location:
  • Phone: 818-818-2180
  • Fax: 209-292-2503
Mailing address:
  • Phone: 818-804-5544
  • Fax: 209-292-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SAMUEL MATINYAN
Title or Position: DIRECTOR
Credential:
Phone: 818-818-2180