Healthcare Provider Details

I. General information

NPI: 1083118996
Provider Name (Legal Business Name): BEYOND BEHAVIOR ANALYSIS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 17TH AVE
MIAMI FL
33125-1547
US

IV. Provider business mailing address

6005 SW 108TH PL
MIAMI FL
33173-1231
US

V. Phone/Fax

Practice location:
  • Phone: 305-773-0544
  • Fax: 305-774-9573
Mailing address:
  • Phone: 305-773-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3918
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH3918
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMH3918
License Number StateFL

VIII. Authorized Official

Name: MS. NILDA M DE LA FE
Title or Position: PRESIDENT
Credential: LMHC
Phone: 305-773-0544