Provider Demographics
NPI:1235662107
Name:COUNIHAN, JOSEPH STEPHEN (BCBA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:COUNIHAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-7103
Mailing Address - Country:US
Mailing Address - Phone:925-329-8954
Mailing Address - Fax:
Practice Address - Street 1:5820 STONERIDGE MALL RD
Practice Address - Street 2:205
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3274
Practice Address - Country:US
Practice Address - Phone:925-329-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-25630103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst