Provider Demographics
NPI:1366715484
Name:SOUTHERN CALIFORNIA BEHAVIORAL COUNSELING
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA BEHAVIORAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/BCBA
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GEER
Authorized Official - Suffix:
Authorized Official - Credentials:MA/BCBA
Authorized Official - Phone:626-789-9400
Mailing Address - Street 1:1507 ANNADEL AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2404
Mailing Address - Country:US
Mailing Address - Phone:626-789-9400
Mailing Address - Fax:
Practice Address - Street 1:1507 ANNADEL AVE
Practice Address - Street 2:TRUE
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2404
Practice Address - Country:US
Practice Address - Phone:626-789-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-03-1090 BCBA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty