Provider Demographics
NPI:1063002095
Name:PRIME BEHAVIORAL SOLUTIONS INC
Entity Type:Organization
Organization Name:PRIME BEHAVIORAL SOLUTIONS INC
Other - Org Name:PRIME BEHAVIORAL SOLUTIONS INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERATSUYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:818-913-5254
Mailing Address - Street 1:121 W LEXINGTON DR STE L300B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2203
Mailing Address - Country:US
Mailing Address - Phone:818-913-5254
Mailing Address - Fax:
Practice Address - Street 1:121 W LEXINGTON DR STE L300B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2203
Practice Address - Country:US
Practice Address - Phone:818-913-5254
Practice Address - Fax:818-484-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty