Provider Demographics
NPI:1407257165
Name:APPLIED BEHAVIORAL LEARNING GROUP, INC.
Entity Type:Organization
Organization Name:APPLIED BEHAVIORAL LEARNING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:818-789-4540
Mailing Address - Street 1:1407 FOOTHILL BLVD # 78
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3451
Mailing Address - Country:US
Mailing Address - Phone:818-789-4540
Mailing Address - Fax:818-789-4541
Practice Address - Street 1:963 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3428
Practice Address - Country:US
Practice Address - Phone:661-224-9310
Practice Address - Fax:800-516-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770836637Medicaid