Provider Demographics
NPI:1851665400
Name:BEAUTIFUL MINDS CENTER FOR AUTISM INC.
Entity Type:Organization
Organization Name:BEAUTIFUL MINDS CENTER FOR AUTISM INC.
Other - Org Name:THE BEAUTIFUL MINDS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZRALSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:310-247-1836
Mailing Address - Street 1:7300 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2467
Mailing Address - Country:US
Mailing Address - Phone:310-247-1836
Mailing Address - Fax:
Practice Address - Street 1:7300 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2467
Practice Address - Country:US
Practice Address - Phone:310-247-1836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCBAOther1-10-7720