Provider Demographics
NPI:1417432386
Name:GAUNT, JESSE GIRARD (BCBA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:GIRARD
Last Name:GAUNT
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15674 POPPYSEED LN
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1850
Mailing Address - Country:US
Mailing Address - Phone:661-993-5627
Mailing Address - Fax:
Practice Address - Street 1:7727 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2475
Practice Address - Country:US
Practice Address - Phone:661-993-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-31557103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst