Provider Demographics
NPI:1205391539
Name:BEHAVIORAL CONCEPTS
Entity Type:Organization
Organization Name:BEHAVIORAL CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RBT
Authorized Official - Prefix:
Authorized Official - First Name:KAZANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO-RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-253-9078
Mailing Address - Street 1:10671 TIBBS CIR APT 8
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-1319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23151 VERDUGO DR STE 113
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1340
Practice Address - Country:US
Practice Address - Phone:949-954-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA618982373Medicaid