Basic Information
| Provider Information | |||||||||
| NPI: | 1528489101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARBOX | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 E HILLCREST DR | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913605828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053794000 | ||||||||
| FaxNumber: | 8054357440 | ||||||||
| Practice Location | |||||||||
| Address1: | 19019 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913563253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183452345 | ||||||||
| FaxNumber: | 8187588015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2013 | ||||||||
| LastUpdateDate: | 12/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-07-3687 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.