MEDICARE: LARK BEHAVIOR GROUP 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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1851986152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARK BEHAVIOR GROUP INC.

Provider Business Mailing Address
First Line	:	9250 RESEDA BLVD UNIT 10082
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3142
Country	:	US
Telephone Number	:	818-916-0295
Fax Number	:

Provider Business Practice Location Address
First Line	:	18200 RINALDI PL
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2551
Country	:	US
Telephone Number	:	818-916-0295
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	SHOGIK MARTIROSYAN
Credential	:	MS
Telephone Number	:	424-354-3731

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	09/25/2024

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