Provider Demographics
NPI:1225887490
Name:BEYOU BEHAVIOR THERAPY SPC
Entity type:Organization
Organization Name:BEYOU BEHAVIOR THERAPY SPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLZANI GREUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-604-6520
Mailing Address - Street 1:5616 HOWELL MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6212
Mailing Address - Country:US
Mailing Address - Phone:949-241-7961
Mailing Address - Fax:
Practice Address - Street 1:5616 HOWELL MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6212
Practice Address - Country:US
Practice Address - Phone:949-241-7961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty