Healthcare Provider Details

I. General information

NPI: 1538074620
Provider Name (Legal Business Name): GENERAL BEHAVIOR ANALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BARTOW RD
LAKELAND FL
33801-5106
US

IV. Provider business mailing address

5406 HOOVER BLVD STE 12
TAMPA FL
33634-5330
US

V. Phone/Fax

Practice location:
  • Phone: 813-369-2501
  • Fax:
Mailing address:
  • Phone: 813-369-2501
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANAI DIAZ
Title or Position: BCBA
Credential: PHD, BCBA
Phone: 813-369-2501