Provider Demographics
NPI:1689326530
Name:BEYOND BRIGHTER MINDS INC
Entity type:Organization
Organization Name:BEYOND BRIGHTER MINDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:SETIADI
Authorized Official - Last Name:GINSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:323-627-9040
Mailing Address - Street 1:22254 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2348
Mailing Address - Country:US
Mailing Address - Phone:323-627-9040
Mailing Address - Fax:
Practice Address - Street 1:22254 SCHOOLCRAFT ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2348
Practice Address - Country:US
Practice Address - Phone:323-627-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty