Provider Demographics
NPI:1669945069
Name:SAHEBI, SALLY (BCBA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:SAHEBI
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 1:2091 BUSINESS CENTER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1167
Mailing Address - Country:US
Mailing Address - Phone:949-250-1101
Mailing Address - Fax:949-250-1103
Practice Address - Street 1:7100 HAYVENHURST AVE # P-H
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3874
Practice Address - Country:US
Practice Address - Phone:818-786-0205
Practice Address - Fax:949-250-1103
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-33656103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst