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General NPI Number Information
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NPI Number | 1154702462
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL BEHAVIORAL INTERVENTIONS
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 100 GRACE AVE
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City | LA HABRA
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State | CA
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Zip | 90631-6846
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Country | US
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Telephone | 562-236-7908
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GRACE AVE
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City | LA HABRA
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State | CA
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Zip | 90631-6846
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Country | US
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Telephone | 562-236-7908
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Fax |
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Authorized Official
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Title or Position | CCO, VICE PRESIDENT
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Name | MRS. AMANDA RENEE PEREZ
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Credential | M.A., M.A., B.C.B.A.
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Telephone | 562-236-7908
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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 |
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License Number State |
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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 |
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License Number State |
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