Provider Demographics
NPI:1053487090
Name:VISTA PSYCHOLOGICAL CENTER, INC
Entity Type:Organization
Organization Name:VISTA PSYCHOLOGICAL CENTER, INC
Other - Org Name:VISTA CENTER FOR BEHAVIOR ANALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H. KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:805-689-6610
Mailing Address - Street 1:3905 STATE ST STE 7-276
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3138
Mailing Address - Country:US
Mailing Address - Phone:805-689-6610
Mailing Address - Fax:805-299-4505
Practice Address - Street 1:23030 LYONS AVE STE 102
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2755
Practice Address - Country:US
Practice Address - Phone:661-425-7066
Practice Address - Fax:805-299-4505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISTA PSYCHOLOGICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11229103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGPS000680Medicaid