Healthcare Provider Details

I. General information

NPI: 1629518451
Provider Name (Legal Business Name): BEHAVIOR WORKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 TANGERINE PL SUITE 403
DAVIE FL
33324-4471
US

IV. Provider business mailing address

9410 TANGERINE PL SUITE 403
DAVIE FL
33324-4471
US

V. Phone/Fax

Practice location:
  • Phone: 954-701-4987
  • Fax:
Mailing address:
  • Phone: 954-701-4987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MICHELE TULL
Title or Position: OWNER
Credential:
Phone: 954-701-4987