MEDICARE: MP BEHAVIORAL CONSULTANTS

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	0-01-0302	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	687683896	OTHER	FL	MEDWAIVER
2	687683898	OTHER	FL	MEDWAIVER

General Provider Information

NPI Number	:	1629349048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MP BEHAVIORAL CONSULTANTS

Provider Business Mailing Address
First Line	:	1925 LAKE POINT DR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-2356
Country	:	US
Telephone Number	:	954-401-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 LAKE POINT DR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-2356
Country	:	US
Telephone Number	:	954-401-2024
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	MRS. MARIA J. PRESTON
Credential	:	M.S. ED,. BCABA
Telephone Number	:	954-401-2024

Provider Enumeration Date	:	01/17/2012
Last Update Date	:	01/17/2012

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Directions to “MP BEHAVIORAL CONSULTANTS ” Practice Location

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