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General NPI Number Information
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NPI Number | 1083238968
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Entity Type | Organization
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Legal Business Name | AGOURA NEUROFEEDBACK
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 5490 FAIRVIEW PL
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City | AGOURA HILLS
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State | CA
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Zip | 91301-2224
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Country | US
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Telephone | 310-848-5418
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Fax |
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Provider Business Mailing Address
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Address Line | 28720 ROADSIDE DR STE 200
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4576
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Country | US
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Telephone | 310-848-5418
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Fax | 855-717-3268
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Authorized Official
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Title or Position | CONSULTANT
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Name | JONATHAN AUSTIN
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Credential |
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Telephone | 213-973-2906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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