Healthcare Provider Details

I. General information

NPI: 1174438550
Provider Name (Legal Business Name): BEHAVIORAL EXCELLENCE AND SKILL TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W INTERNATIONAL SPEEDWAY BLVD STE 81
DAYTONA BEACH FL
32114-4322
US

IV. Provider business mailing address

48 PERGOLA PL
ORMOND BEACH FL
32174-1059
US

V. Phone/Fax

Practice location:
  • Phone: 386-456-4921
  • Fax: 251-309-4480
Mailing address:
  • Phone: 863-327-7550
  • Fax: 251-309-4480

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: MACHELISE SIMONE GIBSON
Title or Position: OWNER/ BCBA
Credential: BCBA
Phone: 863-327-7550