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General NPI Number Information
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NPI Number | 1962994525
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Entity Type | Organization
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Legal Business Name | SEACOAST BEHAVIOR, LLC
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 536 SHOREBIRD WAY
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932
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Country | US
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Telephone | 757-404-8176
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Fax |
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Provider Business Mailing Address
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Address Line | 536 SHOREBIRD WAY
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-2155
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MALERIE GEST
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Credential |
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Telephone | 619-836-0829
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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 | 1-17-26403
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License Number State | AL
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