Provider Demographics
NPI:1538567334
Name:BX TECHNOLOGIES
Entity type:Organization
Organization Name:BX TECHNOLOGIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:916-526-0722
Mailing Address - Street 1:11470 SUNRISE GOLD CIR STE 7
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-6541
Mailing Address - Country:US
Mailing Address - Phone:916-526-0722
Mailing Address - Fax:855-365-1125
Practice Address - Street 1:11470 SUNRISE GOLD CIR STE 7
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-6541
Practice Address - Country:US
Practice Address - Phone:916-526-0722
Practice Address - Fax:855-365-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1084578103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568781615OtherCURRENT NPI NUMBER (PERSONAL)
CA12421587OtherCAQH