Provider Demographics
NPI:1851986152
Name:LARK BEHAVIOR GROUP INC.
Entity Type:Organization
Organization Name:LARK BEHAVIOR GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:SHOGIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIROSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:424-354-3731
Mailing Address - Street 1:301 E FAIRVIEW AVE
Mailing Address - Street 2:UNIT 302
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1995
Mailing Address - Country:US
Mailing Address - Phone:424-354-3731
Mailing Address - Fax:424-354-3731
Practice Address - Street 1:301 E FAIRVIEW AVE
Practice Address - Street 2:UNIT 302
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1995
Practice Address - Country:US
Practice Address - Phone:818-970-5210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty