Healthcare Provider Details

I. General information

NPI: 1831608207
Provider Name (Legal Business Name): UNLIMITED POSSIBILITIES BEHAVIOR & TRANSITIONS SUPPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4438 DAVIS ST
MARIANNA FL
32446-3125
US

IV. Provider business mailing address

5865 NEALS LANDING RD
BASCOM FL
32423-9213
US

V. Phone/Fax

Practice location:
  • Phone: 850-272-6099
  • Fax:
Mailing address:
  • Phone: 850-569-5827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-23058
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17417368844
License Number StateFL

VIII. Authorized Official

Name: ANN MARIE SHELTON
Title or Position: BEHAVIOR ANALYST/CO-FOUNDER
Credential: BCBA
Phone: 850-569-5827