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General NPI Number Information
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NPI Number | 1780134585
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Entity Type | Organization
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Legal Business Name | FAMILY BEHAVIOR ANALYSIS
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 2072 DRACENA DR
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City | LOS ANGELES
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State | CA
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Zip | 90027-2605
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Country | US
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Telephone | 818-296-7282
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Fax |
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Provider Business Mailing Address
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Address Line | 2072 DRACENA DR
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City | LOS ANGELES
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State | CA
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Zip | 90027-2605
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Country | US
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Telephone | 818-296-7282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH CONKLIN
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Credential | BCBA
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Telephone | 818-296-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11417703
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License Number State | CA
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