Provider Demographics
NPI:1225779549
Name:CREATE BEHAVIOR CHANGE CONSULTING, LLC, LIMITED LIABILITY CO.
Entity Type:Organization
Organization Name:CREATE BEHAVIOR CHANGE CONSULTING, LLC, LIMITED LIABILITY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURGA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:916-622-5537
Mailing Address - Street 1:9128 HOURGLASS CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8654
Mailing Address - Country:US
Mailing Address - Phone:916-622-5537
Mailing Address - Fax:
Practice Address - Street 1:110 GATEWAY DR.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648
Practice Address - Country:US
Practice Address - Phone:916-729-3098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty