MEDICARE: BEHAVIORAL DEVELOPMENT GROUP OF LOS ANGELES, LLC

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

General Provider Information

NPI Number	:	1184077059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL DEVELOPMENT GROUP OF LOS ANGELES, LLC

Provider Business Mailing Address
First Line	:	9350 WILSHIRE BLVD STE 203
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9350 WILSHIRE BLVD STE 203
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3204
Country	:	US
Telephone Number	:	347-283-9365
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	RYAN COX
Credential	:
Telephone Number	:	347-283-9365

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	07/15/2016

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