Provider Demographics
NPI:1033755822
Name:EDUCATIONAL & BEHAVIORAL SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:EDUCATIONAL & BEHAVIORAL SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / BEHAVIOR ANALYSTS
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BELTON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D
Authorized Official - Phone:760-953-6500
Mailing Address - Street 1:17100 BEAR VALLEY RD # B-534
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8320
Mailing Address - Country:US
Mailing Address - Phone:760-953-6500
Mailing Address - Fax:
Practice Address - Street 1:13125 CLIPPER DRIVE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5185
Practice Address - Country:US
Practice Address - Phone:760-953-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty