NPIMap

Individual provider Active NPI

Nissa Intarachote Van Etten

  • Behavior Analyst
  • Walnut Creek, CA
National Provider Identifier
1093087181
Registry record updated Feb 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1084077 Issued in CA
Practice address
311 Lennon LN
Suite a
Walnut Creek, CA 94598-2418
Phone
(925) 210-9370
Fax
(925) 210-0436
NPI assigned
Feb 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1084077 CA Primary

Addresses

Primary practice location

311 Lennon LN
Suite a
Walnut Creek, CA 94598-2418

Mailing address

311 Lennon LN
Suite a
Walnut Creek, CA 94598-2418
Phone (925) 210-9370

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1084077CAMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Behavior Analysts, Inc. Behavior Analyst Past Accepting new patients
Behavior Analysts, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328227200000",
    "number": "1093087181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 LENNON LN",
            "address_2": "SUITE A",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982418",
            "telephone_number": "925-210-9370",
            "fax_number": "925-210-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 LENNON LN",
            "address_2": "SUITE A",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982418",
            "telephone_number": "925-210-9370",
            "fax_number": "925-210-0436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INTARACHOTE VAN ETTEN",
        "first_name": "NISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-03",
        "last_updated": "2012-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1084077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.