Applied Behavior Analysis (ABA) County Service Form

Applied Behavior Analysis (ABA)
County Service Form
Anthem Blue Cross provider directories help our members connect with ABA providers timely when
accessing care. You can help keep our online directories accurate by providing us with the counties you
serve.
Return completed form by email to [email protected]
Date
Tax Identification Number (TIN)
ABA Group Practice Name
Check () all the counties your practice serves, whether the entire county or the majority of the county.
Based on the counties you select, your practice will display in Provider Finder search results whether any
city or zip within a particular county is selected, or the county itself is selected.
ALAMEDA
ALPINE
AMADOR
BUTTE
CALAVERAS
COLUSA
CONTRA COSTA
DEL NORTE
EL DORADO
FRESNO
GLENN
HUMBOLDT
IMPERIAL
INYO
KERN
KINGS
LAKE
LASSEN
LOS ANGELES
MADERA
MARIN
MARIPOSA
MENDOCINO
MERCED
MODOC
MONO
MONTEREY
NAPA
NEVADA
ORANGE
PLACER
PLUMAS
RIVERSIDE
SACRAMENTO
SAN BENITO
SAN BERNARDINO
SAN DIEGO
SAN FRANCISCO
SAN JOAQUIN
SAN LUIS OBISPO
SAN MATEO
SANTA BARBARA
SANTA CLARA
SANTA CRUZ
SHASTA
SIERRA
SISKIYOU
SOLANO
SONOMA
STANISLAUS
SUTTER
TEHAMA
TRINITY
TULARE
TUOLUMNE
VENTURA
YOLO
YUBA
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