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General NPI Number Information
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NPI Number | 1780918102
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Entity Type | Organization
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Legal Business Name | LAURA ADDISON DBA ADDISON BEHAVIORAL RESOURCES
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 266 MOBIL AVE SUITE 209
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City | CAMARILLO
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State | CA
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Zip | 93010-6328
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Country | US
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Telephone | 805-383-5566
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Fax | 888-659-0031
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Provider Business Mailing Address
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Address Line | 266 MOBIL AVE SUITE 209
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City | CAMARILLO
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State | CA
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Zip | 93010-6328
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Country | US
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Telephone | 805-383-5566
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Fax | 888-659-0031
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Authorized Official
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Title or Position | CEO
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Name | DR. LAURA R. ADDISON
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Credential | PHD, BCBA
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Telephone | 805-383-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | PSY 22059
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-05-2114
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License Number State |
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