| Behavioranalystsupervisor | |
|
809 Mccloud Ave Mount Shasta CA 96067-9603 | |
| (530) 227-2883 | |
| Not Available |
| Full Name | Behavioranalystsupervisor |
|---|---|
| Speciality | Behavior Analyst |
| Location | 809 Mccloud Ave, Mount Shasta, California |
| Authorized Official Name and Position | Kevin M Van Laeken (OWNER/OPERATOR) |
| Authorized Official Contact | 5302272883 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioranalystsupervisor 809 Mccloud Ave Mount Shasta CA 96067-9603 Ph: (530) 227-2883 | Behavioranalystsupervisor 809 Mccloud Ave Mount Shasta CA 96067-9603 Ph: (530) 227-2883 |
| NPI Number | 1790157154 |
|---|---|
| Provider Enumeration Date | 10/26/2015 |
| Last Update Date | 10/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790157154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-13-12972 (California) | Primary |
| 103TS0200X | Psychologist - School | LEP3635 (California) | Secondary |
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