Healthcare Provider Details

I. General information

NPI: 1598203010
Provider Name (Legal Business Name): JAMIE RUNYONS-HIERS ED.S. NCSP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1015 NW 56TH TER
GAINESVILLE FL
32605-4481
US

IV. Provider business mailing address

175 MIDDLE ST SUITE 1201
LAKE MARY FL
32746-3625
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-5520
  • Fax:
Mailing address:
  • Phone: 866-610-0580
  • Fax: 866-610-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-22686
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: