Healthcare Provider Details

I. General information

NPI: 1437049202
Provider Name (Legal Business Name): KINGDOM BEHAVIOR PRINCIPLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 MARTIN LN
KISSIMMEE FL
34759-4527
US

IV. Provider business mailing address

718 MARTIN LN
KISSIMMEE FL
34759-4527
US

V. Phone/Fax

Practice location:
  • Phone: 352-272-7217
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: RODNEY L HOGAN JR.
Title or Position: OWNER/BCBA
Credential: BCBA
Phone: 352-272-7217