Provider Demographics
NPI:1669956074
Name:BEHAVIORAL EDUCATION SKILL TREATMENT CENTER
Entity type:Organization
Organization Name:BEHAVIORAL EDUCATION SKILL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:PEICHEN
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:626-512-0627
Mailing Address - Street 1:867 GOLDEN PRADOS DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1927
Mailing Address - Country:US
Mailing Address - Phone:909-802-6868
Mailing Address - Fax:
Practice Address - Street 1:17802 SKY PARK CIR STE 105
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6405
Practice Address - Country:US
Practice Address - Phone:949-202-0257
Practice Address - Fax:949-271-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty