Provider Demographics
NPI:1528105582
Name:BEHAVIOR MATTERS
Entity type:Organization
Organization Name:BEHAVIOR MATTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAVERNIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-424-4654
Mailing Address - Street 1:2161 SAINT LAWRENCE STREET
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504
Mailing Address - Country:US
Mailing Address - Phone:909-424-4654
Mailing Address - Fax:909-784-5044
Practice Address - Street 1:3634 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2506
Practice Address - Country:US
Practice Address - Phone:909-424-4654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS18030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty