| Behavioranalystsupervisor | |
|
809 Mccloud Ave Mount Shasta CA 96067-9603 | |
| (530) 227-2883 | |
| Not Available |
| Full Name | Behavioranalystsupervisor |
|---|---|
| Speciality | Behavior Analyst |
| Location | 809 Mccloud Ave, Mount Shasta, California |
| Authorized Official Name and Position | Kevin M Van Laeken (OWNER/OPERATOR) |
| Authorized Official Contact | 5302272883 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioranalystsupervisor 809 Mccloud Ave Mount Shasta CA 96067-9603 Ph: (530) 227-2883 | Behavioranalystsupervisor 809 Mccloud Ave Mount Shasta CA 96067-9603 Ph: (530) 227-2883 |
| NPI Number | 1790157154 |
|---|---|
| Provider Enumeration Date | 10/26/2015 |
| Last Update Date | 10/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790157154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-13-12972 (California) | Primary |
| 103TS0200X | Psychologist - School | LEP3635 (California) | Secondary |
Mbs Integrative Psychiatry Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 214 E Lake St, Mount Shasta, CA 96067 Phone: 530-435-5048 Fax: 602-603-5084 | |
Jefferson Neurology, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 822 Pine St, Mount Shasta, CA 96067 Phone: 530-926-1039 | |
Diana Muncy Lmft Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1005 Ream Ave, Mount Shasta, CA 96067 Phone: 530-941-2259 | |
County Of Siskiyou Behavioral Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1107 Ream Ave, Mount Shasta, CA 96067 Phone: 530-918-7200 Fax: 530-918-7216 | |
Revive Medical Group Ca Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 914 Pine St, Mount Shasta, CA 96067 Phone: 203-430-1321 | |
Blair Rhodes Mft Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 618 N Mount Shasta Blvd, Mount Shasta, CA 96067 Phone: 530-925-4480 Fax: 530-926-3450 |