MEDICARE: ATLAS ACADEMY, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst
3	106E00000X	Assistant Behavior Analyst
4	106S00000X	Behavior Technician
5	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1619653318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS ACADEMY, INC

Provider Business Mailing Address
First Line	:	23 RYBAR LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-6445
Country	:	US
Telephone Number	:	386-316-3004
Fax Number	:	386-220-8281

Provider Business Practice Location Address
First Line	:	1621 ESPANOLA AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-1745
Country	:	US
Telephone Number	:	386-283-0553
Fax Number	:	386-220-8281

Authorized Official
Title or Position	:	CEO
Name	:	MS. MELISSA ANN MOSSFORD-CARROLL
Credential	:	BCBA, LMHC
Telephone Number	:	386-316-3004

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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Directions to “ATLAS ACADEMY, INC ” Practice Location

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