Healthcare Provider Details

I. General information

NPI: 1649034638
Provider Name (Legal Business Name): AYL BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 CARDINAL ST E # 33974
LEHIGH ACRES FL
33974-0512
US

IV. Provider business mailing address

648 CARDINAL ST E
LEHIGH ACRES FL
33974-0512
US

V. Phone/Fax

Practice location:
  • Phone: 786-325-4721
  • Fax:
Mailing address:
  • Phone: 786-325-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YISET GARCIA
Title or Position: THERAPIST/ OWNER
Credential: CBHT
Phone: 786-325-4721