Provider Demographics
NPI:1437493749
Name:BEHAVIORAL LEARNING CENTER
Entity Type:Organization
Organization Name:BEHAVIORAL LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-254-7086
Mailing Address - Street 1:27240 TURNBERRY LN STE 240
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1017
Mailing Address - Country:US
Mailing Address - Phone:661-254-7086
Mailing Address - Fax:
Practice Address - Street 1:27240 TURNBERRY LN STE 240
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1017
Practice Address - Country:US
Practice Address - Phone:661-254-7086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11211851251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health