Provider Demographics
NPI:1518574466
Name:ENRICHED BEHAVIORAL THERAPY
Entity Type:Organization
Organization Name:ENRICHED BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:HERNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCBA
Authorized Official - Phone:323-638-1656
Mailing Address - Street 1:3036 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6106
Mailing Address - Country:US
Mailing Address - Phone:323-638-1656
Mailing Address - Fax:
Practice Address - Street 1:3036 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6106
Practice Address - Country:US
Practice Address - Phone:323-236-8327
Practice Address - Fax:855-250-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty