Healthcare Provider Details

I. General information

NPI: 1528465150
Provider Name (Legal Business Name): GREATER PENSACOLA BEHAVIOR SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 DOCTORS PARK
MILTON FL
32570-5073
US

IV. Provider business mailing address

4122 WILLIAMSON LN
MILTON FL
32571-2237
US

V. Phone/Fax

Practice location:
  • Phone: 850-723-6570
  • Fax:
Mailing address:
  • Phone: 786-525-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA HALL
Title or Position: PRESIDENT
Credential:
Phone: 786-525-6658