Provider Demographics
NPI:1932575909
Name:PRAISE BEHAVIOR SERVICE INC.
Entity type:Organization
Organization Name:PRAISE BEHAVIOR SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:O'GORMAN-TRIMBATH
Authorized Official - Suffix:
Authorized Official - Credentials:MA BCBA
Authorized Official - Phone:269-352-3660
Mailing Address - Street 1:370 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2512
Mailing Address - Country:US
Mailing Address - Phone:269-352-3660
Mailing Address - Fax:
Practice Address - Street 1:370 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2512
Practice Address - Country:US
Practice Address - Phone:269-352-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-5707251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health