Provider Demographics
NPI:1992012439
Name:ADAMS, MARK A (BCBA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 MILLERTON RD
Mailing Address - Street 2:
Mailing Address - City:FRIANT
Mailing Address - State:CA
Mailing Address - Zip Code:93626-9736
Mailing Address - Country:US
Mailing Address - Phone:559-313-3309
Mailing Address - Fax:559-765-0963
Practice Address - Street 1:6080 MILLERTON RD
Practice Address - Street 2:
Practice Address - City:FRIANT
Practice Address - State:CA
Practice Address - Zip Code:93626-9736
Practice Address - Country:US
Practice Address - Phone:559-313-3309
Practice Address - Fax:559-765-0963
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-01-0378103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst