Provider Demographics
NPI:1043663529
Name:KENT, EBY (LEP, BCBA)
Entity Type:Individual
Prefix:
First Name:EBY
Middle Name:
Last Name:KENT
Suffix:
Gender:M
Credentials:LEP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16191 TOMAS LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2432
Mailing Address - Country:US
Mailing Address - Phone:714-552-6720
Mailing Address - Fax:
Practice Address - Street 1:2 CORPORATE PLAZA DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7929
Practice Address - Country:US
Practice Address - Phone:714-552-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-15212103K00000X
CA3101103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool