Healthcare Provider Details

I. General information

NPI: 1780221382
Provider Name (Legal Business Name): PIERCE TAYLOR II BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 TARA CREEK CT
PACE FL
32571-8005
US

IV. Provider business mailing address

5116 TARA CREEK CT
PACE FL
32571-8005
US

V. Phone/Fax

Practice location:
  • Phone: 850-910-1522
  • Fax:
Mailing address:
  • Phone: 850-910-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-12476
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-104933
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-863
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: