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NPI Code Detail

MEDICARE: APPLIED BEHAVIORAL LEARNING EXPERIENCES, INC

MEDICARE: APPLIED BEHAVIORAL LEARNING EXPERIENCES, 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
1261Q00000XClinic/Center
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760627905
Entity Type Code : Organization
Provider Name (Legal Business Name) : APPLIED BEHAVIORAL LEARNING EXPERIENCES, INC
Provider Business Mailing Address
First Line : PO BOX 2112
Second Line :
City : LAKELAND
State : FL
Zip : 33806-2112
Country : US
Telephone Number : 863-581-1583
Fax Number : 863-644-9590
Provider Business Practice Location Address
First Line : 454 W PIPKIN RD
Second Line :
City : LAKELAND
State : FL
Zip : 33813-2545
Country : US
Telephone Number : 863-619-2809
Fax Number : 863-646-9590
Authorized Official
Title or Position : BEHAVIOR ANALYST
Name : MRS. STACEY LYN OSMON
Credential : M.S. ED, BCBA
Telephone Number : 863-581-1583
Provider Enumeration Date : 12/02/2008
Last Update Date : 08/22/2022

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