Provider Demographics
NPI:1093184152
Name:KIM, ELIZABETH J (BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26565 AGOURA RD # 119
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1984
Mailing Address - Country:US
Mailing Address - Phone:310-612-4220
Mailing Address - Fax:
Practice Address - Street 1:26565 AGOURA RD # 119
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1984
Practice Address - Country:US
Practice Address - Phone:310-612-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-12911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst