Provider Demographics
NPI:1598182164
Name:YOUNG, BETH ANNE STARR (BCBA)
Entity Type:Individual
Prefix:
First Name:BETH ANNE
Middle Name:STARR
Last Name:YOUNG
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 1:2200 HARBOR BLVD.
Mailing Address - Street 2:#C-120
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:949-910-6767
Mailing Address - Fax:877-268-3922
Practice Address - Street 1:2200 HARBOR BLVD.
Practice Address - Street 2:#C-120
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:949-910-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-12638103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst