=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417465030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIOR AND DEVELOPMENT CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2018
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13488 MAXELLA AVE
-----------------------------------------------------
City | MARINA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-208-1551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13488 MAXELLA AVE APT 569
-----------------------------------------------------
City | MARINA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90292-4305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-484-1230
-----------------------------------------------------
Fax | 833-651-9996
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF RCM
-----------------------------------------------------
Name | JAY MYERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-484-1230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------