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General NPI Number Information
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NPI Number | 1114300597
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Entity Type | Organization
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Legal Business Name | PLATINUM BEHAVIORAL MANAGEMENT
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Dates
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Enumeration Date | 07/03/2015
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Last Update Date | 07/03/2015
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Provider Practice Location Address
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Address Line | 18003 FLYNN DR UNIT 542
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-4919
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Country | US
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Telephone | 661-992-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 18003 FLYNN DR UNIT 542
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-4919
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Country | US
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Telephone | 661-992-3610
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | KIMBERLY MICHELLE BENJAMIN
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Credential | BCBA
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Telephone | 661-992-3610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1-12-11854
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-12-11854
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License Number State | CA
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