=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578324984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOCIAL BEHAVIOR EDUCATION CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2024
-----------------------------------------------------
Last Update Date | 01/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23612 VIA ESTELLA
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-485-2126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23612 VIA ESTELLA
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, CHIEF CLINICAL OFFICER
-----------------------------------------------------
Name | SOHEYLA TORABI
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 909-485-2126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------