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18522 Us Highway 18 Ste 207 Apple Valley CA 92307-2321 | |
| (442) 327-9172 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 18522 Us Highway 18 Ste 207, Apple Valley, California |
| Authorized Official Name and Position | Harry L Jackson (CEO) |
| Authorized Official Contact | 4423279172 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15490 Civic Dr Ste 103 Victorville CA 92392-2382 Ph: (442) 327-9172 | 18522 Us Highway 18 Ste 207 Apple Valley CA 92307-2321 Ph: (442) 327-9172 |
| NPI Number | 1013540731 |
|---|---|
| Provider Enumeration Date | 02/20/2020 |
| Last Update Date | 05/22/2023 |
| Certification Date | 05/22/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013540731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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