Provider Demographics
NPI:1083375851
Name:LEADING BEHAVIORAL CHANGE LLC
Entity Type:Organization
Organization Name:LEADING BEHAVIORAL CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:LEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:760-554-0366
Mailing Address - Street 1:1724 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4160
Mailing Address - Country:US
Mailing Address - Phone:760-222-2283
Mailing Address - Fax:
Practice Address - Street 1:1724 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4160
Practice Address - Country:US
Practice Address - Phone:760-222-2283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty