Provider Demographics
NPI:1750782660
Name:TO, THAO (MA, BCBA)
Entity type:Individual
Prefix:
First Name:THAO
Middle Name:
Last Name:TO
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11 SHERIDAN LN
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1245
Mailing Address - Country:US
Mailing Address - Phone:800-249-1266
Mailing Address - Fax:800-385-8191
Practice Address - Street 1:11358 KNOTT ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-1400
Practice Address - Country:US
Practice Address - Phone:800-249-1266
Practice Address - Fax:800-385-8191
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CABCBA 1-14-16377103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst