Provider Demographics
NPI:1982151064
Name:JADE BEHAVIORAL CONSULTANTS
Entity Type:Organization
Organization Name:JADE BEHAVIORAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:A
Authorized Official - Last Name:TILMON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:818-577-8743
Mailing Address - Street 1:2115 W CRESCENT AVE STE 244
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3836
Mailing Address - Country:US
Mailing Address - Phone:818-577-8743
Mailing Address - Fax:
Practice Address - Street 1:2115 W CRESCENT AVE STE 244
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3836
Practice Address - Country:US
Practice Address - Phone:818-577-8743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-10254251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health