Organization
LLKD21 LLC
Active
Other names
Tailored Behavior
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL WATKINS BCBA (VICE PRESIDENT)
(310) 767-6354
Entity
Organization
Contact information
Practice address
1230 ROSECRANS AVE STE 300, MANHATTAN BEACH, CA 90266-2494
(888) 361-2660
Mailing address
1230 ROSECRANS AVE STE 300, PMB #792, MANHATTAN BEACH, CA 90266-2494
(888) 361-2660
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
08/25/2021
Last updated
08/03/2022
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