Provider Demographics
NPI:1578013777
Name:FLOURISH ABA BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:FLOURISH ABA BEHAVIORAL HEALTH SERVICES
Other - Org Name:FLOURISH ABA BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTZBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:714-581-8660
Mailing Address - Street 1:1912 N BROADWAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2641
Mailing Address - Country:US
Mailing Address - Phone:714-581-8660
Mailing Address - Fax:714-955-4397
Practice Address - Street 1:1912 N BROADWAY
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2621
Practice Address - Country:US
Practice Address - Phone:714-581-8660
Practice Address - Fax:714-955-4397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTWAY ABA BEHAVIORAL HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-12
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14995103K00000X
CA106E00000X, 106S00000X
251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13855358OtherCAQH