Healthcare Provider Details

I. General information

NPI: 1912517830
Provider Name (Legal Business Name): BEHAVIORIAL JOURNEYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 ELPINE WAY
PALM BEACH GARDENS FL
33418-7848
US

IV. Provider business mailing address

5162 ELPINE WAY
PALM BEACH GARDENS FL
33418-7848
US

V. Phone/Fax

Practice location:
  • Phone: 609-332-3454
  • Fax:
Mailing address:
  • Phone: 609-332-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARI UTAIN
Title or Position: OWNER/BCABA
Credential: BCABA
Phone: 609-332-3454