Provider Demographics
NPI:1407368822
Name:ITS BEHAVIORAL
Entity Type:Organization
Organization Name:ITS BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHROTRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:805-407-4533
Mailing Address - Street 1:3230 ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1322
Mailing Address - Country:US
Mailing Address - Phone:805-407-4533
Mailing Address - Fax:
Practice Address - Street 1:3230 ORANGE DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1322
Practice Address - Country:US
Practice Address - Phone:805-407-4533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-24322103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty