Provider Demographics
NPI:1497189310
Name:CHILD COMMUNICATION AND BEHAVIOR SPECIALISTS
Entity Type:Organization
Organization Name:CHILD COMMUNICATION AND BEHAVIOR SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:COUNTIE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:866-227-1211
Mailing Address - Street 1:1494 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-4535
Mailing Address - Country:US
Mailing Address - Phone:866-227-1211
Mailing Address - Fax:
Practice Address - Street 1:1494 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4535
Practice Address - Country:US
Practice Address - Phone:866-227-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106E00000X, 106S00000X
CA1-12-12666251C00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty