Provider Demographics
NPI:1346667144
Name:ELITE BEHAVIORAL THERAPIES, INC.
Entity Type:Organization
Organization Name:ELITE BEHAVIORAL THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:SEPIDEH
Authorized Official - Last Name:FASSIH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:818-835-3284
Mailing Address - Street 1:4501 CEDROS AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2801
Mailing Address - Country:US
Mailing Address - Phone:818-835-3284
Mailing Address - Fax:
Practice Address - Street 1:4501 CEDROS AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2801
Practice Address - Country:US
Practice Address - Phone:818-835-3284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty