Healthcare Provider Details

I. General information

NPI: 1639855224
Provider Name (Legal Business Name): MORLY GOURDET BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W STATE ROAD 434 STE 1000
LONGWOOD FL
32750-4969
US

IV. Provider business mailing address

315 LAKE SEMINARY CIR
MAITLAND FL
32751-3310
US

V. Phone/Fax

Practice location:
  • Phone: 689-304-9638
  • Fax:
Mailing address:
  • Phone: 561-201-2076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2854443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: