Healthcare Provider Details

I. General information

NPI: 1356068514
Provider Name (Legal Business Name): LUCAS HUNTLEY HORTON BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 LAKE ELLENOR DR
ORLANDO FL
32809-4633
US

IV. Provider business mailing address

200 MAITLAND AVE APT 232
ALTAMONTE SPRINGS FL
32701-5570
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax:
Mailing address:
  • Phone: 404-312-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-16995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: