Basic Information
Provider Information | |||||||||
NPI: | 1619258712 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LEARNING AND BEHAVIORAL CENTER,LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 21230 PROVIDENCIA ST | ||||||||
Address2: |   | ||||||||
City: | WOODLAND HILLS | ||||||||
State: | CA | ||||||||
PostalCode: | 913643221 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8187055522 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 18663 VENTURA BLVD STE 301 | ||||||||
Address2: |   | ||||||||
City: | TARZANA | ||||||||
State: | CA | ||||||||
PostalCode: | 913564161 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8187055522 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/01/2011 | ||||||||
LastUpdateDate: | 09/01/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GHATAN | ||||||||
AuthorizedOfficialFirstName: | BITA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO/ THERAPIST | ||||||||
AuthorizedOfficialTelephone: | 8187055522 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MISS | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.