MEDICARE: LARSEN & WILLIAMS BEHAVIORAL CONSULTANTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	11410454	CA

General Provider Information

NPI Number	:	1033503784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARSEN & WILLIAMS BEHAVIORAL CONSULTANTS INC

Provider Business Mailing Address
First Line	:	11500 W OLYMPIC BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1525
Country	:	US
Telephone Number	:	323-331-8988
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 W OLYMPIC BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1525
Country	:	US
Telephone Number	:	323-331-8988
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MISS CHIANTE WILLIAMS
Credential	:
Telephone Number	:	323-331-8988

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	03/20/2015

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