Provider Demographics
NPI:1902388622
Name:CLEVINGER, ADAM (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:CLEVINGER
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 HAWTHORNE BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6834
Mailing Address - Country:US
Mailing Address - Phone:310-901-4345
Mailing Address - Fax:310-792-2878
Practice Address - Street 1:25500 HAWTHORNE BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6834
Practice Address - Country:US
Practice Address - Phone:310-901-4345
Practice Address - Fax:310-792-2878
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-30394103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst