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General NPI Number Information
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NPI Number | 1033593397
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL SUPPORT PARTNERSHIP
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 12443 LEWIS ST SUITE 201
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4650
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Country | US
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Telephone | 714-748-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 522 WYCLIFFE
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City | IRVINE
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State | CA
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Zip | 92602-1213
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Country | US
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Telephone | 818-304-1313
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Fax |
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Authorized Official
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Title or Position | CASE SUPERVISOR
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Name | MISS CRYSTAL MICHELLE GUTIERREZ
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Credential | M.A., BCBA
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Telephone | 818-304-1313
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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 | 1-15-18868
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License Number State | CA
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