Healthcare Provider Details

I. General information

NPI: 1760627905
Provider Name (Legal Business Name): APPLIED BEHAVIORAL LEARNING EXPERIENCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 W PIPKIN RD
LAKELAND FL
33813-2545
US

IV. Provider business mailing address

PO BOX 2112
LAKELAND FL
33806-2112
US

V. Phone/Fax

Practice location:
  • Phone: 863-619-2809
  • Fax: 863-646-9590
Mailing address:
  • Phone: 863-581-1583
  • Fax: 863-644-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY LYN OSMON
Title or Position: BEHAVIOR ANALYST
Credential: M.S. ED, BCBA
Phone: 863-581-1583