Provider Demographics
NPI:1871231191
Name:HIGINBOTHAM, ERIC (RBT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HIGINBOTHAM
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N HOLLYWOOD WAY APT 206
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3163
Mailing Address - Country:US
Mailing Address - Phone:951-768-5730
Mailing Address - Fax:
Practice Address - Street 1:1932 N NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1819
Practice Address - Country:US
Practice Address - Phone:951-768-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-71442106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician