Healthcare Provider Details

I. General information

NPI: 1083534929
Provider Name (Legal Business Name): BEHAVIORAL PROGRESSION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E PINE STREET 1252
LAKELAND FL
33801
US

IV. Provider business mailing address

304 E PINE ST # 1252
LAKELAND FL
33801-4969
US

V. Phone/Fax

Practice location:
  • Phone: 813-602-0068
  • Fax:
Mailing address:
  • Phone: 813-602-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MCLEAN MINARD
Title or Position: OWNER
Credential:
Phone: 813-602-0068