Provider Demographics
NPI:1376059626
Name:GOULD, STEPHANIE (BEHAVIORAL ANALYST)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:BEHAVIORAL ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 WARNER AVE # 339
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:800-273-4292
Mailing Address - Fax:714-596-6274
Practice Address - Street 1:3535 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5901
Practice Address - Country:US
Practice Address - Phone:800-273-4292
Practice Address - Fax:888-293-3374
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10213175103K00000X
ORABA-IN-10180342106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician