Basic Information
| Provider Information | |||||||||
| NPI: | 1255883302 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEHAVIORAL & EDUCATIONAL STRATEGIES & TRAINING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2825 W RUMBLE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953500185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095799444 | ||||||||
| FaxNumber: | 2095799494 | ||||||||
| Practice Location | |||||||||
| Address1: | 2825 W RUMBLE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953500185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095799444 | ||||||||
| FaxNumber: | 2095799494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2016 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | SALES | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 2095799444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 80000791 | 01 | CA | EIN | OTHER |