Healthcare Provider Details

I. General information

NPI: 1013348176
Provider Name (Legal Business Name): ORVILLE LYTTLE BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 GARFIELD ST
HOLLYWOOD FL
33021-5152
US

IV. Provider business mailing address

5821 GARFIELD ST
HOLLYWOOD FL
33021-5152
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-3201
  • Fax: 888-889-6290
Mailing address:
  • Phone: 954-987-3201
  • Fax: 888-889-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1096646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: