MEDICARE: LAKELAND BEHAVIORAL SERVICES INC

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

General Provider Information

NPI Number	:	1649975699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKELAND BEHAVIORAL SERVICES INC

Provider Business Mailing Address
First Line	:	1730 ROTARY DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-6846
Country	:	US
Telephone Number	:	863-600-7686
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 ROTARY DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-6846
Country	:	US
Telephone Number	:	786-389-6153
Fax Number	:	863-583-8324

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALEJANDRO CLARO MARTIN
Credential	:
Telephone Number	:	786-389-6153

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/11/2026

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