Provider Demographics
NPI:1407698558
Name:BEHAVIORAL THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:BEHAVIORAL THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MA BCBA
Authorized Official - Phone:909-837-7727
Mailing Address - Street 1:11086 KADOTA AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-3945
Mailing Address - Country:US
Mailing Address - Phone:909-837-7727
Mailing Address - Fax:
Practice Address - Street 1:11086 KADOTA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-3945
Practice Address - Country:US
Practice Address - Phone:909-837-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty