NPIMap

Organization Active NPI

Vivid Minds Therapy LLC

  • Behavior Analyst
  • Fullerton, CA
National Provider Identifier
1811659428
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
VIVID MINDS THERAPY LLC
Practice address
1630 W Gage Ave
Fullerton, CA 92833-4526
Phone
(714) 598-7204
Fax
(714) 586-5161
NPI assigned
Oct 11, 2021
Last updated
Oct 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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

Authorized official

Name
Silvia Gutierrez, BCBANPI 1760946008
Title
Executive Clinical Director
Phone
(714) 598-7204

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X NU Primary

Addresses

Primary practice location

1630 W Gage Ave
Fullerton, CA 92833-4526

Mailing address

1630 W Gage Ave
Fullerton, CA 92833-4526
Phone (714) 598-7204

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633910400000",
    "number": "1811659428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 W GAGE AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334526",
            "telephone_number": "714-598-7204",
            "fax_number": "714-586-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 W GAGE AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334526",
            "telephone_number": "714-598-7204",
            "fax_number": "714-586-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVID MINDS THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "SILVIA",
        "authorized_official_title_or_position": "EXECUTIVE CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "714-598-7204",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; 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.