| Organization Name: | BEACON AUTISTIC SPECTRUM INDEPENDENCE CENTER- B.A.S.I.C. |
| NPI Number: | 1750783890 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY JO LANG (CEO) |
| Mailing Address: | 24 Centerpointe Dr La Palma |
| State: | CA US |
| Postal Code: | 906231028 |
| Phone Number: | 7142884200 |
| Fax Number: | 7147074316 |
| NPI Enumeration Date: | 09/19/2014 |
| NPI Last Update Date: | 09/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PSY12076 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |