1235408089 NPI number — BEHAVIORAL RESEARCH SPECIALISTS, LLC

Table of content: (NPI 1235408089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235408089 NPI number — BEHAVIORAL RESEARCH SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL RESEARCH SPECIALISTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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NPI Number Information

NPI Number:
1235408089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 W. CALIFORNIA BLVD
Provider Second Line Business Mailing Address:
#194
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-524-0000
Provider Business Mailing Address Fax Number:
818-255-7744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 N. MARYLAND AVE
Provider Second Line Business Practice Location Address:
#309
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-524-0000
Provider Business Practice Location Address Fax Number:
818-255-7744
Provider Enumeration Date:
12/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CARR
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
818-524-0000

Provider Taxonomy Codes

  • Taxonomy code: 103TP0016X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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