Provider Demographics
NPI:1053870741
Name:QUALITY LIFE EXPERIENCE
Entity type:Organization
Organization Name:QUALITY LIFE EXPERIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA
Authorized Official - Phone:818-456-2470
Mailing Address - Street 1:4723 1/4 VISTA DEL MONTE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-456-2470
Mailing Address - Fax:
Practice Address - Street 1:4723 1/4 VISTA DEL MONTE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-456-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty