Provider Demographics
NPI:1326454034
Name:KAVOULAKIS, STAVROS (BCBA)
Entity Type:Individual
Prefix:MR
First Name:STAVROS
Middle Name:
Last Name:KAVOULAKIS
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 1:20606 S VERMONT AVE UNIT 41
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20606 S VERMONT AVE
Practice Address - Street 2:UNIT 41
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1565
Practice Address - Country:US
Practice Address - Phone:310-386-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-16110103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst