Provider Demographics
NPI:1114392271
Name:EAST BAY ABA
Entity Type:Organization
Organization Name:EAST BAY ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUNSHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-999-4410
Mailing Address - Street 1:2010 CROW CANYON PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2010 CROW CANYON PL
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4634
Practice Address - Country:US
Practice Address - Phone:510-999-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health