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Organization
PASSPORT TO ADAPTIVE LIVING
Active
Organization
PASSPORT TO ADAPTIVE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY WILSON M.A. BCBA (CLINICAL DIRECTOR)
(805) 339-0210
Entity
Organization
Contact information
Practice address
2291 PORTOLA ROAD, UNIT A, VENTURA, CA 93003
(805) 339-0210
Mailing address
2291 PORTOLA ROAD, UNIT A, VENTURA, CA 93003
(805) 339-0210
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-16-7052
CA
Other
Enumeration date
04/14/2016
Last updated
04/14/2016
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