=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235650516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPERT ABA CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 S LAKE AVE STE 300
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-432-5491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 S LAKE AVE STE 300
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-432-5491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | DR. LAWRENCE TANIFORM
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 626-432-5491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-14-9821
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------