Provider Demographics
NPI:1386189082
Name:BERGHAUSER, JESSICA CHEN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHEN
Last Name:BERGHAUSER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:21045 CAROB LN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6627
Mailing Address - Country:US
Mailing Address - Phone:562-201-7119
Mailing Address - Fax:
Practice Address - Street 1:22365 EL TORO RD STE 151
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5053
Practice Address - Country:US
Practice Address - Phone:562-201-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-24501103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst