Provider Demographics
NPI:1811398050
Name:ENGLE, GARY (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:ENGLE
Suffix:
Gender:M
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6784
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-6784
Mailing Address - Country:US
Mailing Address - Phone:805-968-2525
Mailing Address - Fax:
Practice Address - Street 1:6980 FALBERG WAY
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-6784
Practice Address - Country:US
Practice Address - Phone:805-968-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-6369103K00000X
CAPSY 12310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst