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General NPI Number Information
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NPI Number | 1750770350
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Entity Type | Organization
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Legal Business Name | MORNING STAR ABA THERAPY LLC
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 32565 GOLDEN LANTERN # B180
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City | DANA POINT
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State | CA
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Zip | 92629-3247
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Country | US
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Telephone | 714-552-1317
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Fax |
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Provider Business Mailing Address
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Address Line | 32565 GOLDEN LANTERN # B180
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City | DANA POINT
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State | CA
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Zip | 92629-3247
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Country | US
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Telephone | 714-552-1317
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. AMANDA DISSMORE
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Credential | M.A., BCBA
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Telephone | 714-552-1317
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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 | 1-13-14639
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License Number State | CA
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