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General NPI Number Information
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NPI Number | 1457694747
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Entity Type | Organization
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Legal Business Name | AGOURA NEUROFEEDBACK, INC.
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 28632 ROADSIDE DR STE 210
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City | AGOURA HILLS
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State | CA
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Zip | 91301-6091
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Country | US
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Telephone | 855-717-3268
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Fax | 805-435-1540
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Provider Business Mailing Address
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Address Line | 28632 ROADSIDE DR STE 210
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City | AGOURA HILLS
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State | CA
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Zip | 91301-6091
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Country | US
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Telephone | 855-717-3268
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Fax | 805-435-1540
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Authorized Official
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Title or Position | OWNER
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Name | SHARI BETH STILLMAN-CORBITT
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Credential |
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Telephone | 310-848-5418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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