Basic Information
| Provider Information | |||||||||
| NPI: | 1003176355 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL LEARNING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28245 AVENUE CROCKER | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913551017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612547086 | ||||||||
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| Address1: | 28245 AVENUE CROCKER | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913551017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612547086 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2012 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | SHEEHY | ||||||||
| AuthorizedOfficialFirstName: | DANIELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8183086226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S., BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-09-6555 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.