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Organization
LEGENDARY BEHAVIORAL SERVICES
Active
Organization
LEGENDARY BEHAVIORAL SERVICES
Active
Other names
Legendary Behavioral Services
Organization subpart
No
Provider details
NPI number
Authorized official
JACK LOPEZ (BCBA/CLINICAL DIRECTOR)
(323) 943-4400
Entity
Organization
Contact information
Practice address
1744 E THACKERY ST, WEST COVINA, CA 91791-3137
(323) 943-4400
Mailing address
1050 LAKES DR #225, PMB #3097, WEST COVINA, CA 91790
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/15/2024
Last updated
05/13/2025
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