Provider Demographics
NPI:1114486685
Name:NGUYEN, JODY QUYNH (BCBA)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:QUYNH
Last Name:NGUYEN
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 1:2063 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4833
Mailing Address - Country:US
Mailing Address - Phone:657-456-8558
Mailing Address - Fax:833-256-3911
Practice Address - Street 1:1411 N BATAVIA ST STE 104
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3526
Practice Address - Country:US
Practice Address - Phone:657-456-8558
Practice Address - Fax:833-256-3911
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-39399103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician