MEDICARE: CONNECT THE DOTS, 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	251S00000X	Community/Behavioral Health Agency	BACB# 1-14-15715	CA

General Provider Information

NPI Number	:	1992197537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECT THE DOTS, LLC

Provider Business Mailing Address
First Line	:	5186 TREOSTI PL
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8772
Country	:	US
Telephone Number	:	209-471-7962
Fax Number	:

Provider Business Practice Location Address
First Line	:	5186 TREOSTI PL
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8772
Country	:	US
Telephone Number	:	209-471-7962
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	RENAE MARI OLIVAS
Credential	:	M.S., BCBA
Telephone Number	:	209-471-7962

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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