Provider Demographics
NPI:1144598467
Name:ADVANCEMENT FOR BEHAVIORAL & EDUCATIONAL DEVELOPMENT & INTERVENTION
Entity Type:Organization
Organization Name:ADVANCEMENT FOR BEHAVIORAL & EDUCATIONAL DEVELOPMENT & INTERVENTION
Other - Org Name:ABEDI, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-250-1101
Mailing Address - Street 1:315 CENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3714
Mailing Address - Country:US
Mailing Address - Phone:949-250-1101
Mailing Address - Fax:949-250-1103
Practice Address - Street 1:315 CENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3714
Practice Address - Country:US
Practice Address - Phone:949-250-1101
Practice Address - Fax:949-250-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1559103K00000X
CA4039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty