Provider Demographics
NPI:1679285381
Name:EATON, JEFF (BCBA)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:EATON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 CYPRESS DR STE A
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5613
Mailing Address - Country:US
Mailing Address - Phone:425-435-5212
Mailing Address - Fax:
Practice Address - Street 1:3880 CYPRESS DR STE A
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5613
Practice Address - Country:US
Practice Address - Phone:425-435-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst