Provider Demographics
NPI:1578829370
Name:SIERRA MADRE LEARNING CENTER TOTAL PROGRAMS, LLC
Entity Type:Organization
Organization Name:SIERRA MADRE LEARNING CENTER TOTAL PROGRAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SURFAS
Authorized Official - Suffix:
Authorized Official - Credentials:LEP, BCBA-D
Authorized Official - Phone:626-355-5160
Mailing Address - Street 1:370 W SIERRA MADRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2714
Mailing Address - Country:US
Mailing Address - Phone:626-355-5160
Mailing Address - Fax:626-355-5173
Practice Address - Street 1:370 W SIERRA MADRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2714
Practice Address - Country:US
Practice Address - Phone:626-355-5160
Practice Address - Fax:626-355-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-06-3013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty