| Third Wave Aba Llc | |
|
161 Peregrine Ln Soquel CA 95073-9770 | |
| (408) 835-2440 | |
| Not Available |
| Full Name | Third Wave Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 161 Peregrine Ln, Soquel, California |
| Authorized Official Name and Position | Camille Dawn Summers (FOUNDER & CLINICAL DIRECTOR) |
| Authorized Official Contact | 8315317123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Third Wave Aba Llc 161 Peregrine Ln Soquel CA 95073-9770 Ph: (408) 835-2440 | Third Wave Aba Llc 161 Peregrine Ln Soquel CA 95073-9770 Ph: (408) 835-2440 |
| NPI Number | 1477254472 |
|---|---|
| Provider Enumeration Date | 03/15/2023 |
| Last Update Date | 04/02/2023 |
| Certification Date | 04/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477254472 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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