Healthcare Provider Details

I. General information

NPI: 1689402166
Provider Name (Legal Business Name): BEHAVIOR PROFESSIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CRYSTAL GROVE BLVD
LUTZ FL
33548-6460
US

IV. Provider business mailing address

220 CRYSTAL GROVE BLVD
LUTZ FL
33548-6460
US

V. Phone/Fax

Practice location:
  • Phone: 813-400-2401
  • Fax: 813-489-4870
Mailing address:
  • Phone: 813-400-2401
  • Fax: 813-489-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JADY LAZO
Title or Position: PRESIDENT
Credential:
Phone: 305-833-3939