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General NPI Number Information
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NPI Number | 1548541873
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Entity Type | Organization
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Legal Business Name | NEUROBEHAVIORAL PROGRAMS, INCORPORATED
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 2659 PORTAGE BAY E APT 204
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City | DAVIS
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State | CA
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Zip | 95616-3050
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Country | US
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Telephone | 707-688-8956
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Fax | 415-663-8985
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Provider Business Mailing Address
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Address Line | 2659 PORTAGE BAY E APT 204
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City | DAVIS
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State | CA
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Zip | 95616-3050
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Country | US
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Telephone | 707-688-8956
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Fax | 415-663-8985
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN EDMUND LEONARD
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Credential | PH.D.
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Telephone | 707-688-8956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY12821
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License Number State | CA
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