Healthcare Provider Details

I. General information

NPI: 1194020172
Provider Name (Legal Business Name): DAGNAN BEHAVIORAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13332 QUEEN PALM RUN
N FT MYERS FL
33903-5294
US

IV. Provider business mailing address

13332 QUEEN PALM RUN
N FT MYERS FL
33903-5294
US

V. Phone/Fax

Practice location:
  • Phone: 239-822-6886
  • Fax:
Mailing address:
  • Phone: 239-822-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1010546
License Number StateFL

VIII. Authorized Official

Name: MS. JAYLENE DAGNAN
Title or Position: OWNER
Credential: BCBA
Phone: 239-822-6886