Provider Demographics
NPI:1396240651
Name:GATES, COURTNEY HALLEY (BCBA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:HALLEY
Last Name:GATES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 LAS VIRGENES RD STE A
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1273
Mailing Address - Country:US
Mailing Address - Phone:818-712-8250
Mailing Address - Fax:818-712-8259
Practice Address - Street 1:5741 LAS VIRGENES RD STE A
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1273
Practice Address - Country:US
Practice Address - Phone:818-712-8250
Practice Address - Fax:818-712-8259
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-31871103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst