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General NPI Number Information
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NPI Number | 1184260341
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Entity Type | Individual
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Provider Name | LINNAE CARISSA EHRLICH
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Gender | Female
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 12395 LEWIS ST STE 202
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4694
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Country | US
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Telephone | 949-531-2232
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Fax |
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Provider Business Mailing Address
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Address Line | 2181 AMERICAN AVE UNIT B
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City | COSTA MESA
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State | CA
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Zip | 92627-3922
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Country | US
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Telephone | 949-531-2232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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