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General NPI Number Information
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NPI Number | 1245052760
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Entity Type | Organization
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Legal Business Name | MIXED BEHAVIOR FOUNDATION
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 6955 FOOTHILL BLVD # 275
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City | OAKLAND
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State | CA
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Zip | 94605-2455
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Country | US
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Telephone | 925-430-8295
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Fax |
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Provider Business Mailing Address
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Address Line | 2872 YGNACIO VALLEY RD # 439
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3534
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Country | US
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Telephone | 925-430-8295
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CFO
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Name | SASHA JACKSON
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Credential |
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Telephone | 925-430-8295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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