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General NPI Number Information
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NPI Number | 1588346175
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE CARE BEHAVIORAL SUPPORTS LLC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 9225 WILSON RANCH RD
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City | PHELAN
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State | CA
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Zip | 92371-7305
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Country | US
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Telephone | 760-265-9510
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 N ST STE N
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | MELISSA CHRISTINE CAREY
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Credential | PSY.D., BCBA, LBA
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Telephone | 760-265-9510
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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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