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General NPI Number Information
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NPI Number | 1063303873
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Entity Type | Organization
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Legal Business Name | FGB BEHAVIORAL CONSULTING, LLC
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 20165 FALLEN LEAF LN
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City | TWAIN HARTE
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State | CA
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Zip | 95383-9401
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Country | US
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Telephone | 209-996-0097
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Fax |
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Provider Business Mailing Address
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Address Line | 20165 FALLEN LEAF LN
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City | TWAIN HARTE
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State | CA
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Zip | 95383-9401
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Country | US
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Telephone | 209-996-0097
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FLORENCIA GENTINETTA BALDWIN
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Credential | BCBA
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Telephone | 209-206-6398
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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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