Healthcare Provider Details

I. General information

NPI: 1205641396
Provider Name (Legal Business Name): BEHAVIOR BUTTERFLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 LOS ALTOS WAY APT 103
ALTAMONTE SPRINGS FL
32714-3273
US

IV. Provider business mailing address

431 LOS ALTOS WAY APT 103
ALTAMONTE SPRINGS FL
32714-3273
US

V. Phone/Fax

Practice location:
  • Phone: 917-704-4653
  • Fax:
Mailing address:
  • Phone: 917-704-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CEASHA SMITH
Title or Position: OWNER
Credential: M.S., BCBA
Phone: 917-704-4653