=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417747072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAPTABILITY MINDSET
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2025
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 S GOLD CANYON ST
-----------------------------------------------------
City | RIDGECREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93555-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-917-6692
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 132 S GOLD CANYON ST
-----------------------------------------------------
City | RIDGECREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93555-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-917-6692
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DIANA LOPEZ
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 661-917-6692
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------