Provider Demographics
NPI:1629400395
Name:BEHAVIORAL LEARNING NETWORK LLC
Entity Type:Organization
Organization Name:BEHAVIORAL LEARNING NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:ELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-933-4499
Mailing Address - Street 1:10700 SANTA MONICA BLVD.
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5643
Mailing Address - Country:US
Mailing Address - Phone:310-933-4499
Mailing Address - Fax:310-933-4134
Practice Address - Street 1:10700 SANTA MONICA BLVD.
Practice Address - Street 2:SUITE 214
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5643
Practice Address - Country:US
Practice Address - Phone:310-933-4499
Practice Address - Fax:310-933-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48133103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty