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General NPI Number Information
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NPI Number | 1205207578
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL LEARNING CENTER, INC.
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 13400 RIVERSIDE DR STE 209
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2545
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Country | US
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Telephone | 818-308-6226
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Fax |
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Provider Business Mailing Address
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Address Line | 28245 AVENUE CROCKER STE 220
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City | VALENCIA
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State | CA
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Zip | 91355-1201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | ALLEN ABRAHAM
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Credential |
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Telephone | 818-308-8226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-15-19807
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License Number State | CA
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