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General NPI Number Information
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NPI Number | 1770255325
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Entity Type | Organization
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Legal Business Name | CONSCIOUS KIDS
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 16836 MARINABAY DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2914
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Country | US
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Telephone | 626-200-2754
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Fax |
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Provider Business Mailing Address
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Address Line | 3106 MACE AVE APT D
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City | COSTA MESA
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State | CA
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Zip | 92626-2548
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Country | US
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Telephone | 626-200-9754
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | ELIZABETH WONG
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Credential | BCBA
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Telephone | 626-200-9754
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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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