1659646529 NPI number — BEHAVIOR SUPPORT SERVICES, INC.

Table of content: (NPI 1659646529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659646529 NPI number — BEHAVIOR SUPPORT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIOR SUPPORT SERVICES, INC.
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:
1659646529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 N LAKEMONT AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-3205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-830-6412
Provider Business Mailing Address Fax Number:
407-830-8413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8069 DRESSAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32818-8235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-319-3207
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
RESEALIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MENTAL HEALTH THERAPIST
Authorized Official Telephone Number:
407-319-3207

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  IMH 9173 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com