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General NPI Number Information
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NPI Number | 1730898297
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Entity Type | Organization
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Legal Business Name | MASSSVCS LLC
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 930 S MOUNT VERNON AVE STE 90
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City | COLTON
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State | CA
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Zip | 92324-3928
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Country | US
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Telephone | 909-660-0097
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Fax |
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Provider Business Mailing Address
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Address Line | 930 S MOUNT VERNON AVE STE 90
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City | COLTON
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State | CA
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Zip | 92324-3928
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Country | US
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Telephone | 909-660-0097
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Fax | 840-788-5546
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JASEMINE MONET LAKEY
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Credential | M.S.
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Telephone | 909-921-1404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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