Provider Demographics
NPI:1588021505
Name:GHANIE, KRYSTEN (BCBA)
Entity type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:
Last Name:GHANIE
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 1:2323 ROOSEVELT BLVD.
Mailing Address - Street 2:SUITE #3
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035
Mailing Address - Country:US
Mailing Address - Phone:818-643-0526
Mailing Address - Fax:818-855-8093
Practice Address - Street 1:2323 ROOSEVELT BLVD.
Practice Address - Street 2:SUITE #3
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035
Practice Address - Country:US
Practice Address - Phone:818-643-0526
Practice Address - Fax:818-855-8093
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB#: 1-13-14223103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst