Provider Demographics
NPI:1285978171
Name:GARD, BRENDAN M (MS, BCBA)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:M
Last Name:GARD
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1505
Mailing Address - Country:US
Mailing Address - Phone:805-264-1394
Mailing Address - Fax:
Practice Address - Street 1:1025 ACORN DR
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1505
Practice Address - Country:US
Practice Address - Phone:805-264-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-11842103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst