Healthcare Provider Details

I. General information

NPI: 1093515868
Provider Name (Legal Business Name): LITTLE MOUNTAIN THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16534 SEGOVIA CIR S
FT LAUDERDALE FL
33331-4612
US

IV. Provider business mailing address

16534 SEGOVIA CIR S
FT LAUDERDALE FL
33331-4612
US

V. Phone/Fax

Practice location:
  • Phone: 305-606-7005
  • Fax:
Mailing address:
  • Phone:
  • 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: KEVIN KLEINBERG
Title or Position: OWNER
Credential: BCBA
Phone: 305-606-7005