Provider Demographics
NPI:1982127106
Name:INGALLS, BENJAMIN ALAN (BCBA 1-19-37577)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALAN
Last Name:INGALLS
Suffix:
Gender:M
Credentials:BCBA 1-19-37577
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 BATH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3623
Mailing Address - Country:US
Mailing Address - Phone:949-751-7233
Mailing Address - Fax:
Practice Address - Street 1:1321 BATH ST UNIT A
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3623
Practice Address - Country:US
Practice Address - Phone:949-751-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1-19-37577103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician