Healthcare Provider Details

I. General information

NPI: 1154753598
Provider Name (Legal Business Name): COURTNEY EHLERS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28245 AVENUE CROCKER STE 220
VALENCIA CA
91355-1201
US

IV. Provider business mailing address

28245 AVENUE CROCKER STE 220
VALENCIA CA
91355-1201
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-7086
  • Fax: 661-254-7108
Mailing address:
  • Phone: 661-254-7086
  • Fax: 661-254-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: