Provider Demographics
NPI:1679926349
Name:ADVANCED BEHAVIORAL LEARNING ENVIRONMENT
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL LEARNING ENVIRONMENT
Other - Org Name:ABLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-441-9493
Mailing Address - Street 1:24522 AGUIRRE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692
Mailing Address - Country:US
Mailing Address - Phone:949-441-9493
Mailing Address - Fax:
Practice Address - Street 1:24522 AGUIRRE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692
Practice Address - Country:US
Practice Address - Phone:949-441-9493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty