=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528548286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIOR TEAM INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2018
-----------------------------------------------------
Last Update Date | 08/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25185 MADISON AVE STE A
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-8977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-344-9922
-----------------------------------------------------
Fax | 951-639-0159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25185 MADISON AVE STE A
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-8977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-344-9922
-----------------------------------------------------
Fax | 951-639-0159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STEFANY RANSHAW
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 951-344-9922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-1623403
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------