1205100997 NPI number — AL BEHAVIORAL CONSULTING LLC

Table of content: (NPI 1205100997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205100997 NPI number — AL BEHAVIORAL CONSULTING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AL BEHAVIORAL CONSULTING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205100997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3265 VIRGINIA ST
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33133-5240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-322-1651
Provider Business Mailing Address Fax Number:
786-429-0462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3265 VIRGINIA ST
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33133-5240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-322-1651
Provider Business Practice Location Address Fax Number:
786-429-0462
Provider Enumeration Date:
02/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LORENZO
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
305-322-1651

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 1-10-7842 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)