=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689541245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NASCENT BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3254 HONOLULU AVE APT B
-----------------------------------------------------
City | LA CRESCENTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91214-3385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-833-3130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3746 FOOTHILL BLVD # 122
-----------------------------------------------------
City | LA CRESCENTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91214-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-833-3130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO & BCBA
-----------------------------------------------------
Name | JAIME KIM
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 626-833-3130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------