Basic Information
| Provider Information | |||||||||
| NPI: | 1184294647 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL & EDUCATIONAL STRATEGIES & TRAINING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2630 W RUMBLE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953500155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092222378 | ||||||||
| FaxNumber: | 2095799494 | ||||||||
| Practice Location | |||||||||
| Address1: | 6385 AUBURN BLVD STE C-4 | ||||||||
| Address2: | |||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956215274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092222378 | ||||||||
| FaxNumber: | 2095799494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2021 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | GREVEMBERG | ||||||||
| AuthorizedOfficialFirstName: | SALLY | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2095799444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEHAVIORAL & EDUCATIONAL STRATEGIES & TRAINING | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.