| Legacy Behavioral Collective, Inc. | |
|
100 Redwood Drive La Honda CA 94020-0332 | |
| (650) 799-4776 | |
| Not Available |
| Full Name | Legacy Behavioral Collective, Inc. |
|---|---|
| Speciality | Behavior Analyst |
| Location | 100 Redwood Drive, La Honda, California |
| Authorized Official Name and Position | Juanita Renee Traver Stine (OWNER) |
| Authorized Official Contact | 6507994776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Behavioral Collective, Inc. Po Box 332 La Honda CA 94020-0332 Ph: (650) 799-4776 | Legacy Behavioral Collective, Inc. 100 Redwood Drive La Honda CA 94020-0332 Ph: (650) 799-4776 |
| NPI Number | 1083542740 |
|---|---|
| Provider Enumeration Date | 05/12/2026 |
| Last Update Date | 05/12/2026 |
| Certification Date | 05/07/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083542740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 252Y00000X | Early Intervention Provider Agency | (* (Not Available)) | Secondary |
Applied Behavior Analysis In Real Life Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Redwood Drive, La Honda, CA 94020 Phone: 650-799-4776 |