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General NPI Number Information
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NPI Number | 1003369687
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Entity Type | Organization
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Legal Business Name | SHORELINE ABA
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 08/01/2016
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Provider Practice Location Address
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Address Line | 377 BLUE DOLPHIN DR
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City | PORT HUENEME
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State | CA
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Zip | 93041-3537
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Country | US
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Telephone | 805-341-9214
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Fax |
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Provider Business Mailing Address
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Address Line | 377 BLUE DOLPHIN DR
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City | PORT HUENEME
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State | CA
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Zip | 93041-3537
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Country | US
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Telephone | 805-341-9214
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR / OWNER
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Name | MICHELLE L EVANS
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Credential | MS, BCBA
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Telephone | 805-341-9214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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