Provider Demographics
NPI:1770255325
Name:CONSCIOUS KIDS
Entity Type:Organization
Organization Name:CONSCIOUS KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:626-200-9754
Mailing Address - Street 1:3106 MACE AVE APT D
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2548
Mailing Address - Country:US
Mailing Address - Phone:626-200-9754
Mailing Address - Fax:
Practice Address - Street 1:16836 MARINABAY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2914
Practice Address - Country:US
Practice Address - Phone:626-200-2754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty