Active NPI
Eleesia Tardy, BEHAVIORAL THERAPIST
- Behavior Analyst
- Tarzana, CA
National Provider Identifier
1194454850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 11939817
- Practice address
- 5530 Corbin Ave
Tarzana, CA 91356-2914 - Phone
- (818) 600-8758
- Fax
- (833) 728-0328
- NPI assigned
- Jun 8, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 11939817 | CA | Primary |
Addresses
Primary practice location
5530 Corbin Ave
Tarzana, CA 91356-2914
Mailing address
5530 Corbin Ave
Tarzana, CA 91356-2914
Phone (818) 600-8758
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0 | Medicaid | CA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | www.fmbtagency.com |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11939817 | CA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654646400000",
"number": "1194454850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5530 CORBIN AVE",
"city": "TARZANA",
"state": "CA",
"postal_code": "913562914",
"telephone_number": "818-600-8758",
"fax_number": "833-728-0328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5530 CORBIN AVE",
"city": "TARZANA",
"state": "CA",
"postal_code": "913562914",
"telephone_number": "818-600-8758",
"fax_number": "833-728-0328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TARDY",
"first_name": "ELEESIA",
"credential": "BEHAVIORAL THERAPIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-08",
"last_updated": "2022-06-08",
"certification_date": "2022-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "11939817",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "www.fmbtagency.com",
"affiliation": "N",
"endpointDescription": "website",
"address_1": "5530 Corbin Ave",
"city": "Tarzana",
"state": "CA",
"country_code": "US",
"postal_code": "913562914",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tarzana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.