Provider Demographics
NPI:1821546359
Name:SOAR BEHAVIORAL THERAPY SERVICES
Entity Type:Organization
Organization Name:SOAR BEHAVIORAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIHEL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:630-373-4999
Mailing Address - Street 1:30804 MOONFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7936
Mailing Address - Country:US
Mailing Address - Phone:951-325-2585
Mailing Address - Fax:951-325-7630
Practice Address - Street 1:30804 MOONFLOWER LN
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7936
Practice Address - Country:US
Practice Address - Phone:951-325-2585
Practice Address - Fax:951-325-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-21712103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty