Healthcare Provider Details

I. General information

NPI: 1376087999
Provider Name (Legal Business Name): FALYNN BAHETH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 COLLEGE BLVD E
NICEVILLE FL
32578-1343
US

IV. Provider business mailing address

7125 NORTHAMPTON DR
BATON ROUGE LA
70811-1732
US

V. Phone/Fax

Practice location:
  • Phone: 850-279-3000
  • Fax: 850-389-2269
Mailing address:
  • Phone: 225-773-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-114547
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13254
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: