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General NPI Number Information
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NPI Number | 1972995959
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Entity Type | Organization
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Legal Business Name | NOVO BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 2007 S MOUNTAIN AVE UNIT 32
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City | ONTARIO
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State | CA
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Zip | 91762-6113
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Country | US
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Telephone | 805-907-8779
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Fax | 190-925-9289
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Provider Business Mailing Address
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Address Line | 2007 S MOUNTAIN AVE UNIT 32
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City | ONTARIO
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State | CA
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Zip | 91762-6113
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Country | US
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Telephone | 805-907-8779
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Fax | 190-925-9289
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. GABRIEL LEE LEON
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Credential | MSW
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Telephone | 805-907-8779
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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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