Provider Demographics
NPI:1750758223
Name:KASBOHM, ALYSSA LEIGH (BCBA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LEIGH
Last Name:KASBOHM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LEIGH
Other - Last Name:SELZINCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 E SUNNYOAKS AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6639
Mailing Address - Country:US
Mailing Address - Phone:408-455-6474
Mailing Address - Fax:
Practice Address - Street 1:125 E SUNNYOAKS AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6639
Practice Address - Country:US
Practice Address - Phone:408-455-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-18095103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst