Healthcare Provider Details

I. General information

NPI: 1417413055
Provider Name (Legal Business Name): CHOICES BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2062 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4285
US

IV. Provider business mailing address

2062 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4285
US

V. Phone/Fax

Practice location:
  • Phone: 321-305-5646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JACQUILYN EUSANIO
Title or Position: OWNER
Credential:
Phone: 321-305-5576