Healthcare Provider Details

I. General information

NPI: 1184598518
Provider Name (Legal Business Name): WILLOW PATH ABA & LEARNING LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 MAITLAND CENTER COMMONS BLVD RM 8
MAITLAND FL
32751-7436
US

IV. Provider business mailing address

1063 MAITLAND CENTER COMMONS BLVD RM 8
MAITLAND FL
32751-7436
US

V. Phone/Fax

Practice location:
  • Phone: 689-326-7019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY MEDINA
Title or Position: OWNER/ BEHAVIOR ANALYST
Credential: M.A, BCBA/LBA
Phone: 689-326-7019