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General NPI Number Information
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NPI Number | 1255062147
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Entity Type | Organization
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Legal Business Name | LIVELY BEHAVIORAL SOLUTIONS LLC
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 8442 REILLY DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646
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Country | US
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Telephone | 513-504-9466
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Fax | 949-607-2963
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Provider Business Mailing Address
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Address Line | 8442 REILLY DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646
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Country | US
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Telephone | 513-504-9466
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Fax | 949-607-2963
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Authorized Official
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Title or Position | CEO
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Name | GABRIELLA JOY NELSON
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Credential | BCBA
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Telephone | 661-300-1272
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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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