Family Model Behavior Therapy

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-15-18352 Issued in CA

Legal business name

FAMILY MODEL BEHAVIOR THERAPY

Practice address

18802 Mandan Street
#901
Canyon Country, CA 91351-3763

Phone

(818) 261-5580

Fax

(661) 367-7778

NPI assigned

Jan 4, 2018

Organization subpart

No

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

Authorized official

Name

Keegan Hart, BCBANPI 1619376803

Title

Clinical Director

Phone

(818) 261-5580

Specialties & licenses 1

Addresses

Other names 1

• Family Model Behavior Therapy Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keegan Hart

  • Behavior Analyst
  • Canyon Country, CA
  • NPI 1619376803
  NPD (past) Authorized official

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

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515024000000",
    "number": "1467969071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18802 MANDAN STREET",
            "address_2": "#901",
            "city": "CANYON COUNTRY",
            "state": "CA",
            "postal_code": "913513763",
            "telephone_number": "818-261-5580",
            "fax_number": "661-367-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18802 MANDAN STREET",
            "address_2": "#901",
            "city": "CANYON COUNTRY",
            "state": "CA",
            "postal_code": "913513763",
            "telephone_number": "818-261-5580",
            "fax_number": "661-367-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MODEL BEHAVIOR THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-04",
        "last_updated": "2018-01-04",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "KEEGAN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "818-261-5580",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-15-18352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Model Behavior Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erica Lauren Siegal, a Licensed Clinical Social Worker Corportation
• Sarah S Erolin
• Angel Joy Malanyaon Estrada, RDHAP
• Kenneth Ezenwa, RN
• Christopher Mark Faldmo, D.C.
• Family Model Behavior Therapy, LLC
• Kelsey Paige Feldman, MA, LMFT
• Rochelle C Feldman, M.D.
• Firmo C. Garcia, M.D.
• Enrique Flores Jr.

• Behavior Analyst in Canyon Country, CA
• Providers in Canyon Country, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2018; 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.