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Organization

CHILD COUNSELING & BEHAVIOR THERAPY CLINIC

Active
Other names
Behavior Therapy Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
MR. WAYNE EDWARD TASHJIAN MFT, BCBA (DIRECTOR)
(818) 788-2388
Entity
Organization

Contact information

Practice address
15720 VENTURA BLVD, SUITE 403, ENCINO, CA 91436-2914
(818) 788-2388
(818) 788-3875
Mailing address
15720 VENTURA BLVD, SUITE 403, ENCINO, CA 91436-2914
(818) 788-2388
(818) 788-3875

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
BCBA # 1-10-7653
CA
251S00000X
Community/Behavioral Health Agency
Primary
MFC30490
CA

Other

Enumeration date
07/27/2012
Last updated
11/01/2012
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