Healthcare Provider Details

I. General information

NPI: 1598167660
Provider Name (Legal Business Name): INTEGRAL BEHAVIOR SOLUTIONS, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR STE 310
DAVIE FL
33328-5310
US

IV. Provider business mailing address

5400 S UNIVERSITY DR STE 110
DAVIE FL
33328-5300
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-3573
  • Fax:
Mailing address:
  • Phone: 305-305-3573
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: YENISLEYDI GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-305-3573