Provider Demographics
NPI:1003602525
Name:CARTER, JEREMY AARON
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:AARON
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GUNDRY AVE
Mailing Address - Street 2:UNIT H
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3522
Mailing Address - Country:US
Mailing Address - Phone:818-618-7013
Mailing Address - Fax:
Practice Address - Street 1:2500 GUNDRY AVE
Practice Address - Street 2:UNIT H
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-3522
Practice Address - Country:US
Practice Address - Phone:818-618-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician