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NPI Code Detail

MEDICARE: ANOVA EDUCATION AND BEHAVIOR CONSULTATION, INC.

MEDICARE: ANOVA EDUCATION AND BEHAVIOR CONSULTATION, 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1538422985
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANOVA EDUCATION AND BEHAVIOR CONSULTATION, INC.
Provider Business Mailing Address
First Line : 2911 CLEVELAND AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2715
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2911 CLEVELAND AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2715
Country : US
Telephone Number : 707-477-2933
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : WILLIAM JAMES HENKEL
Credential : BCBA, MA
Telephone Number : 707-527-7032
Provider Enumeration Date : 06/20/2012
Last Update Date : 06/20/2012

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