Healthcare Provider Details

I. General information

NPI: 1386038966
Provider Name (Legal Business Name): NATURAL BEHAVIOR SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4168 TIMUQUANA RD
JACKSONVILLE FL
32210-8543
US

IV. Provider business mailing address

4168 TIMUQUANA RD
JACKSONVILLE FL
32210-8543
US

V. Phone/Fax

Practice location:
  • Phone: 904-465-0090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1063045
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. MERRILL MARTIN
Title or Position: OWNER
Credential: BCBA
Phone: 904-465-0090