Healthcare Provider Details

I. General information

NPI: 1366305476
Provider Name (Legal Business Name): BEHAVIOR EDUCATION SERVICES TEAM LA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 COFFEEN AVE # 1200
SHERIDAN WY
82801-5777
US

IV. Provider business mailing address

1309 COFFEEN AVE # 1200
SHERIDAN WY
82801-5777
US

V. Phone/Fax

Practice location:
  • Phone: 562-736-6122
  • Fax:
Mailing address:
  • Phone: 562-736-6122
  • Fax:

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. EDWIN FLORES
Title or Position: CONTRACTS COORDINATOR
Credential:
Phone: 562-736-6122