MEDICARE: PARTNERS IN BEHAVIORAL SUPPORT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548704836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS IN BEHAVIORAL SUPPORT, LLC

Provider Business Mailing Address
First Line	:	9536 SUNBELT ST UNIT 108
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-6019
Country	:	US
Telephone Number	:	407-459-0482
Fax Number	:

Provider Business Practice Location Address
First Line	:	9536 SUNBELT ST UNIT 108
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-6019
Country	:	US
Telephone Number	:	407-459-0482
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARTISA REGISTER
Credential	:
Telephone Number	:	407-459-0482

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	11/06/2024

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