1710116223 NPI number — LEARNING AND BEHAVIORAL CENTER. LLC

Table of content: DAVE GOODEN MSW LCSW (NPI 1275793002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710116223 NPI number — LEARNING AND BEHAVIORAL CENTER. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEARNING AND BEHAVIORAL CENTER. 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:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710116223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5554 RESEDA BLVD.
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91356-4162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-705-5522
Provider Business Mailing Address Fax Number:
818-705-0522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18663 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-4162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-705-5522
Provider Business Practice Location Address Fax Number:
818-705-0522
Provider Enumeration Date:
07/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GHATAN
Authorized Official First Name:
BITA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
818-705-5522

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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