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General NPI Number Information
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NPI Number | 1033755822
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Entity Type | Organization
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Legal Business Name | EDUCATIONAL & BEHAVIORAL SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 11/27/2019
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 13125 CLIPPER DRIVE
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City | VICTORVILLE
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State | CA
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Zip | 92395-5185
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Country | US
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Telephone | 760-953-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 17100 BEAR VALLEY RD # B-534
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City | VICTORVILLE
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State | CA
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Zip | 92395-8320
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Country | US
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Telephone | 760-953-6500
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Fax |
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Authorized Official
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Title or Position | OWNER / BEHAVIOR ANALYSTS
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Name | DR. KEITH E. BELTON
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Credential | BCBA-D
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Telephone | 760-953-6500
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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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