Provider Demographics
NPI:1083238968
Name:AGOURA NEUROFEEDBACK
Entity Type:Organization
Organization Name:AGOURA NEUROFEEDBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-973-2906
Mailing Address - Street 1:28720 ROADSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4576
Mailing Address - Country:US
Mailing Address - Phone:310-848-5418
Mailing Address - Fax:855-717-3268
Practice Address - Street 1:5490 FAIRVIEW PL
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2224
Practice Address - Country:US
Practice Address - Phone:310-848-5418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility