MEDICARE: EY BEHAVIORAL SERVICES, 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

General Provider Information

NPI Number	:	1629747548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EY BEHAVIORAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	7027 CAMINO DEGRAZIA UNIT 208
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7811
Country	:	US
Telephone Number	:	619-727-3926
Fax Number	:

Provider Business Practice Location Address
First Line	:	7027 CAMINO DEGRAZIA UNIT 208
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7811
Country	:	US
Telephone Number	:	619-727-3926
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELEMY YEME
Credential	:
Telephone Number	:	619-727-3926

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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