Provider Demographics
NPI:1780458570
Name:STRIVE ABC A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:STRIVE ABC A PSYCHOLOGICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LASCANO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:626-209-9042
Mailing Address - Street 1:1420 N CLAREMONT BLVD STE 102B
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3583
Mailing Address - Country:US
Mailing Address - Phone:626-209-9042
Mailing Address - Fax:
Practice Address - Street 1:1420 N CLAREMONT BLVD STE 102B
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3583
Practice Address - Country:US
Practice Address - Phone:626-209-9042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty