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General NPI Number Information
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NPI Number | 1609301001
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Entity Type | Organization
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Legal Business Name | CHANGE FACTORS ANALYSIS
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 92 N BERKELEY AVE
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City | PASADENA
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State | CA
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Zip | 91107-3548
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Country | US
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Telephone | 818-448-9215
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Fax |
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Provider Business Mailing Address
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Address Line | 92 N BERKELEY AVE
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City | PASADENA
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State | CA
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Zip | 91107-3548
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Country | US
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Telephone | 818-448-9215
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | KELLY TERNENT
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Credential |
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Telephone | 818-448-9215
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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 | 1107517
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License Number State | CA
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