Provider Demographics
NPI:1639316029
Name:CALIFORNIA INSTITUTE OF BEHAVIOR ANALYSIS
Entity Type:Organization
Organization Name:CALIFORNIA INSTITUTE OF BEHAVIOR ANALYSIS
Other - Org Name:LEAFWING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUBBERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-442-0921
Mailing Address - Street 1:2127 W ORANGEWOOD AVE
Mailing Address - Street 2:#B
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1954
Mailing Address - Country:US
Mailing Address - Phone:714-634-8500
Mailing Address - Fax:800-832-2321
Practice Address - Street 1:2127 W. ORANGEWOOD AVE.
Practice Address - Street 2:#B
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-634-8500
Practice Address - Fax:800-832-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50185106H00000X
CABCBA1-01-0404252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty