Provider Demographics
NPI:1417331836
Name:BACON, JULIETTE (BCBA)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:BACON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 E 2ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3958
Mailing Address - Country:US
Mailing Address - Phone:888-582-2974
Mailing Address - Fax:
Practice Address - Street 1:5580 E 2ND ST STE 101
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3958
Practice Address - Country:US
Practice Address - Phone:888-582-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst