Basic Information
| Provider Information | |||||||||
| NPI: | 1780978858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOTPRINTS BEHAVIORAL INTERVENTIONS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FOOTPRINTS BEHAVIORAL INTERVENTIONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 CARNEGIE AVE STE 1C | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927055504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148558895 | ||||||||
| FaxNumber: | 7145966274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 CARNEGIE AVE | ||||||||
| Address2: | SUITE 1-C | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927055504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148488319 | ||||||||
| FaxNumber: | 7145966274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2011 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | HUONG | ||||||||
| AuthorizedOfficialMiddleName: | DIEM | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7148558895 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MA | ||||||||
| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 1052376 | CA | N | Agencies | Community/Behavioral Health | 106S00000X | N | 193200000X MULTI-SPECIALTY GROUP | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 251C00000X | 1052376 | CA | N | Agencies | Day Training, Developmentally Disabled Services | 106E00000X | N | 193200000X MULTI-SPECIALTY GROUP | 252Y00000X | 1052376 | CA | Y | Agencies | Early Intervention Provider Agency |
No ID Information.