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Organization
BX TECHNOLOGIES
Active
Organization
BX TECHNOLOGIES
Active
Other names
Spark Behavior Consulting
Organization subpart
No
Provider details
NPI number
Authorized official
IAN GLEN WILSON BCBA (CEO)
(916) 526-0722
Entity
Organization
Contact information
Practice address
11470 SUNRISE GOLD CIR STE 7, RANCHO CORDOVA, CA 95742-6541
(916) 526-0722
(855) 365-1125
Mailing address
11470 SUNRISE GOLD CIR STE 7, RANCHO CORDOVA, CA 95742-6541
(916) 526-0722
(855) 365-1125
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1084578
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12421587
CAQH
CA
01
—
1568781615
CURRENT NPI NUMBER (PERSONAL)
CA
Enumeration date
12/10/2014
Last updated
12/10/2014
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