Provider Demographics
NPI:1801141106
Name:EAST BAY ABA GROUP
Entity type:Organization
Organization Name:EAST BAY ABA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUNSHELL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:510-999-4410
Mailing Address - Street 1:2821 CROW CANYON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1659
Mailing Address - Country:US
Mailing Address - Phone:510-999-4410
Mailing Address - Fax:877-565-6451
Practice Address - Street 1:2821 CROW CANYON RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1659
Practice Address - Country:US
Practice Address - Phone:510-999-4410
Practice Address - Fax:877-565-6451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty