Provider Demographics
NPI:1770839714
Name:WINDROSE BEHAVIOR DIRECTIONS
Entity Type:Organization
Organization Name:WINDROSE BEHAVIOR DIRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COOK KLASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-743-0701
Mailing Address - Street 1:1840 W WHITTIER BLVD # 202
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3623
Mailing Address - Country:US
Mailing Address - Phone:562-734-0701
Mailing Address - Fax:562-691-0701
Practice Address - Street 1:1916 VIRAZON DRIVE
Practice Address - Street 2:
Practice Address - City:LA HABRA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:90631-7779
Practice Address - Country:US
Practice Address - Phone:562-743-0701
Practice Address - Fax:562-691-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12-10522103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty