Organization
BEHAVIORANALYSTSUPERVISOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN M VAN LAEKEN BCBA, LEP (OWNER/OPERATOR)
(530) 227-2883
Entity
Organization
Contact information
Practice address
809 MCCLOUD AVE, MOUNT SHASTA, CA 96067-9603
(530) 227-2883
Mailing address
809 MCCLOUD AVE, MOUNT SHASTA, CA 96067-9603
(530) 227-2883
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-13-12972
CA
103TS0200X
School Psychologist
LEP3635
CA
Other
Enumeration date
10/26/2015
Last updated
10/26/2015
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