Provider Demographics
NPI:1972995959
Name:NOVO BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:NOVO BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:805-907-8779
Mailing Address - Street 1:2007 S MOUNTAIN AVE UNIT 32
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6113
Mailing Address - Country:US
Mailing Address - Phone:805-907-8779
Mailing Address - Fax:190-925-9289
Practice Address - Street 1:2007 S MOUNTAIN AVE UNIT 32
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6113
Practice Address - Country:US
Practice Address - Phone:805-907-8779
Practice Address - Fax:190-925-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11415578OtherBCBA