Provider Demographics
NPI:1447642939
Name:NOVO BEHAVIORIAL SERVICES
Entity type:Organization
Organization Name:NOVO BEHAVIORIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:805-907-8779
Mailing Address - Street 1:429 E AMERIGE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2005
Mailing Address - Country:US
Mailing Address - Phone:805-907-8779
Mailing Address - Fax:
Practice Address - Street 1:429 E AMERIGE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2005
Practice Address - Country:US
Practice Address - Phone:805-907-8779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty