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General NPI Number Information
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NPI Number | 1811390081
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Entity Type | Organization
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Legal Business Name | ABA WORKS
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 11340 W OLYMPIC BLVD 250
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City | LOS ANGELES
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State | CA
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Zip | 90064-1608
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Country | US
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Telephone | 310-456-4937
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Fax | 888-286-8715
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Provider Business Mailing Address
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Address Line | 2633 LINCOLN BLVD 520
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City | SANTA MONICA
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State | CA
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Zip | 90405
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Country | US
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Telephone | 310-456-4937
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Fax | 888-286-8715
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. WILLEMIJN JOHANNA CAMPBELL
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Credential | BCBA, MFT
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Telephone | 310-456-4937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC47309
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11212499
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 11212499
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | MFC47309
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License Number State | CA
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