Provider Demographics
NPI:1164712188
Name:PRAKASH, JOHN-PAUL AGUSTIN (BCBA)
Entity Type:Individual
Prefix:MR
First Name:JOHN-PAUL
Middle Name:AGUSTIN
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16530 VENTURA BLVD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4554
Mailing Address - Country:US
Mailing Address - Phone:818-582-2217
Mailing Address - Fax:818-501-0470
Practice Address - Street 1:16530 VENTURA BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4554
Practice Address - Country:US
Practice Address - Phone:818-582-2217
Practice Address - Fax:818-501-0470
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8259103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst