Healthcare Provider Details

I. General information

NPI: 1972173227
Provider Name (Legal Business Name): BEHAVIORAL INTERVENTION THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 OLEANDER AVE
FORT PIERCE FL
34982-6426
US

IV. Provider business mailing address

4273 SW MCCLELLEN ST
PORT ST LUCIE FL
34953-6135
US

V. Phone/Fax

Practice location:
  • Phone: 772-233-6446
  • Fax: 772-264-3990
Mailing address:
  • Phone: 561-398-5309
  • 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: MRS. SHANNON S PRINCE
Title or Position: FOUNDER
Credential: BCBA
Phone: 561-398-5309