MEDICARE: BEHAVIORAL BUILDING BLOCKS, 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	252Y00000X	Early Intervention Provider Agency	1-04-1577	CA

General Provider Information

NPI Number	:	1184989360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL BUILDING BLOCKS, INC

Provider Business Mailing Address
First Line	:	15335 MORRISON ST
Second Line	:	SUITE 235
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1513
Country	:	US
Telephone Number	:	818-990-1265
Fax Number	:	818-990-0929

Provider Business Practice Location Address
First Line	:	15335 MORRISON ST
Second Line	:	SUITE 235
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1513
Country	:	US
Telephone Number	:	818-990-1265
Fax Number	:	818-990-0929

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ANKI SJOLUND
Credential	:	M.S., BCBA
Telephone Number	:	310-383-4799

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	07/12/2012

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