Basic Information
| Provider Information | |||||||||
| NPI: | 1255699732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEHAVIORAL & EDUCATIONAL STRATEGIES & TRAINING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5716 PIRRONE RD | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953689313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095799444 | ||||||||
| FaxNumber: | 2095799444 | ||||||||
| Practice Location | |||||||||
| Address1: | 5716 PIRRONE RD | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953689313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095799444 | ||||||||
| FaxNumber: | 2095799444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2012 | ||||||||
| LastUpdateDate: | 05/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | GREVEMBERG | ||||||||
| AuthorizedOfficialFirstName: | SALLY | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2095799444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.A., B.C.B.A. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 80000791 | 01 | CA | EIN | OTHER |