Provider Demographics
NPI:1457174658
Name:ELLAFAY BEHAVIORAL CONSULTING LLC
Entity type:Organization
Organization Name:ELLAFAY BEHAVIORAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLNEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:951-732-7257
Mailing Address - Street 1:8207 ARLINGTON AVE # 219
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0429
Mailing Address - Country:US
Mailing Address - Phone:951-732-7257
Mailing Address - Fax:
Practice Address - Street 1:8207 ARLINGTON AVE # 219
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0429
Practice Address - Country:US
Practice Address - Phone:951-732-7257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health