Basic Information
| Provider Information | |||||||||
| NPI: | 1396255246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JULIA | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 ROSECRANS AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902662496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104061500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 31344 VIA COLINAS STE 108 | ||||||||
| Address2: | |||||||||
| City: | WESTLAKE VILLAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913626797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053793212 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2017 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
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 | 26-291-5096 | 01 | CA | ACCORD CORPORATION | OTHER |