Provider Demographics
NPI:1568600674
Name:MYHRA, JENNIE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:MYHRA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7676 HAZARD CENTER DR STE 500
Mailing Address - Street 2:C/O: THE CENTER FOR BEHAVIOR CHANGE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4508
Mailing Address - Country:US
Mailing Address - Phone:619-301-2262
Mailing Address - Fax:
Practice Address - Street 1:7676 HAZARD CENTER DR STE 500
Practice Address - Street 2:C/O: THE CENTER FOR BEHAVIOR CHANGE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4508
Practice Address - Country:US
Practice Address - Phone:619-301-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-08-4883103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst