Provider Demographics
NPI:1255672382
Name:MITROO, TEJAL (MA, BCBA)
Entity type:Individual
Prefix:
First Name:TEJAL
Middle Name:
Last Name:MITROO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16530 VENTURA BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4504
Mailing Address - Country:US
Mailing Address - Phone:818-501-4240
Mailing Address - Fax:818-501-0470
Practice Address - Street 1:16530 VENTURA BLVD STE 510
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4504
Practice Address - Country:US
Practice Address - Phone:818-501-4240
Practice Address - Fax:818-501-0470
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-12806103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst