Provider Demographics
NPI: | 1346667144 |
---|---|
Name: | ELITE BEHAVIORAL THERAPIES, INC. |
Entity type: | Organization |
Organization Name: | ELITE BEHAVIORAL THERAPIES, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE CLINICAL DIRECTOR, CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | DAWN |
Authorized Official - Middle Name: | SEPIDEH |
Authorized Official - Last Name: | FASSIH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, BCBA |
Authorized Official - Phone: | 818-835-3284 |
Mailing Address - Street 1: | 4501 CEDROS AVE |
Mailing Address - Street 2: | SUITE 124 |
Mailing Address - City: | SHERMAN OAKS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91403-2801 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 818-835-3284 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4501 CEDROS AVE |
Practice Address - Street 2: | SUITE 124 |
Practice Address - City: | SHERMAN OAKS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91403-2801 |
Practice Address - Country: | US |
Practice Address - Phone: | 818-835-3284 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-19 |
Last Update Date: | 2014-03-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty |