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General NPI Number Information
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NPI Number | 1437398542
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Entity Type | Organization
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Legal Business Name | EXTRAORDINARY OPTIONS
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 1776 E CENTURY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90002-3050
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Country | US
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Telephone | 310-721-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 10736 JEFFERSON BLVD. 262
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City | CULVER CITY
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State | CA
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Zip | 90230
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Country | US
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Telephone | 310-721-2411
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | ANDREA BROWN
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Credential |
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Telephone | 310-721-2411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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 | CA
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