Provider Demographics
NPI:1578804852
Name:GRUMMON, AMANDA YUKI (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:YUKI
Last Name:GRUMMON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13440 VENTURA BLVD
Mailing Address - Street 2:200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3850
Mailing Address - Country:US
Mailing Address - Phone:818-442-0921
Mailing Address - Fax:
Practice Address - Street 1:13440 VENTURA BLVD
Practice Address - Street 2:200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3850
Practice Address - Country:US
Practice Address - Phone:818-442-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13132103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst