Healthcare Provider Details

I. General information

NPI: 1972307122
Provider Name (Legal Business Name): GULF COAST CHILDREN THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 NE 1ST AVE
CAPE CORAL FL
33909-4226
US

IV. Provider business mailing address

3949 EVANS AVE STE 401B
FORT MYERS FL
33901-9345
US

V. Phone/Fax

Practice location:
  • Phone: 305-527-5636
  • Fax:
Mailing address:
  • Phone: 305-527-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: YENIBET HERNANDEZ BETANCOURT
Title or Position: OWNER
Credential:
Phone: 305-527-5636