Healthcare Provider Details

I. General information

NPI: 1760677017
Provider Name (Legal Business Name): BEHAVIOR ANALYSIS SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 16TH AVE BLDG D
GAINESVILLE FL
32601-4541
US

IV. Provider business mailing address

PO BOX 357370
GAINESVILLE FL
32635-7370
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax: 352-332-8589
Mailing address:
  • Phone: 352-332-8588
  • Fax: 352-332-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN DENNIS ADELINIS
Title or Position: PRESIDENT
Credential: BCBA, M.A
Phone: 352-332-8588