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General NPI Number Information
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NPI Number | 1528798212
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Entity Type | Organization
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Legal Business Name | PRECIOUS TIME INCLUSION PROGRAM LLC
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1401 21ST ST STE R
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 804-272-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 18375 VENTURA BLVD UNIT 179
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City | TARZANA
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State | CA
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Zip | 91356-4218
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Country | US
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Telephone | 804-651-0226
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE COORDINATOR
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Name | TAMMY BOWEN
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Credential |
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Telephone | 804-898-9331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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