Provider Demographics
NPI:1780918102
Name:LAURA ADDISON DBA ADDISON BEHAVIORAL RESOURCES
Entity type:Organization
Organization Name:LAURA ADDISON DBA ADDISON BEHAVIORAL RESOURCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:805-383-5566
Mailing Address - Street 1:266 MOBIL AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6328
Mailing Address - Country:US
Mailing Address - Phone:805-383-5566
Mailing Address - Fax:888-659-0031
Practice Address - Street 1:266 MOBIL AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6328
Practice Address - Country:US
Practice Address - Phone:805-383-5566
Practice Address - Fax:888-659-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22059252Y00000X
1-05-2114103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty