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General NPI Number Information
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NPI Number | 1144598467
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Entity Type | Organization
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Legal Business Name | ADVANCEMENT FOR BEHAVIORAL & EDUCATIONAL DEVELOPMENT & INTERVENTION
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 315 CENTENNIAL WAY
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City | TUSTIN
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State | CA
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Zip | 92780-3714
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Country | US
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Telephone | 949-250-1101
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Fax | 949-250-1103
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Provider Business Mailing Address
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Address Line | 315 CENTENNIAL WAY
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City | TUSTIN
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State | CA
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Zip | 92780-3714
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Country | US
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Telephone | 949-250-1101
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Fax | 949-250-1103
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Authorized Official
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Title or Position | MANAGER OF ADMINISTRATIVE SERVICES
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Name | RHONDA MARIE RIVAS
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Credential |
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Telephone | 949-250-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4039
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-04-1559
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License Number State | CA
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