Organization
BEACON AUTISTIC SPECTRUM INDEPENDENCE CENTER- B.A.S.I.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY JO LANG PHD (CEO)
(714) 288-4200
Entity
Organization
Contact information
Practice address
24 CENTERPOINTE DR, LA PALMA, CA 90623-1028
(714) 288-4200
(714) 707-4316
Mailing address
24 CENTERPOINTE DR, LA PALMA, CA 90623-1028
(714) 288-4200
(714) 707-4316
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY12076
CA
103K00000X
Behavior Analyst
Primary
PSY12076
CA
Other
Enumeration date
09/19/2014
Last updated
09/19/2014
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