Provider Demographics
NPI:1417552951
Name:SON, JI HYEA (BCBA)
Entity Type:Individual
Prefix:
First Name:JI HYEA
Middle Name:
Last Name:SON
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 1:29283 BROKEN ARROW WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2722
Mailing Address - Country:US
Mailing Address - Phone:860-884-0872
Mailing Address - Fax:
Practice Address - Street 1:27349 JEFFERSON AVE STE 114
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5610
Practice Address - Country:US
Practice Address - Phone:858-689-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA10000363103K00000X
CO12364931103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst