Provider Demographics
NPI:1790397180
Name:GUIDING STRIDES LLC
Entity Type:Organization
Organization Name:GUIDING STRIDES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:714-390-2662
Mailing Address - Street 1:14175 PASEO CORTO
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2013
Mailing Address - Country:US
Mailing Address - Phone:714-390-2662
Mailing Address - Fax:
Practice Address - Street 1:14175 PASEO CORTO
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2013
Practice Address - Country:US
Practice Address - Phone:714-390-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty