Provider Demographics
NPI:1639831779
Name:BACLIT, SAVANNAH FAITH
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:FAITH
Last Name:BACLIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 MYRA AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4559
Mailing Address - Country:US
Mailing Address - Phone:714-828-6400
Mailing Address - Fax:714-828-3400
Practice Address - Street 1:5340 MYRA AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4569
Practice Address - Country:US
Practice Address - Phone:714-828-6400
Practice Address - Fax:714-828-3400
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician