Healthcare Provider Details

I. General information

NPI: 1548464423
Provider Name (Legal Business Name): BEHAVIOR SERVICES OF BREVARD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SOLUTIONS WAY
ROCKLEDGE FL
32955-3620
US

IV. Provider business mailing address

550 SOLUTIONS WAY
ROCKLEDGE FL
32955-3620
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-9800
  • Fax: 321-639-6007
Mailing address:
  • Phone: 321-639-9800
  • Fax: 321-639-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. KAREN R WAGNER
Title or Position: OWNER/ CLINICAL DIRECTOR
Credential: FL LMHC, BCBA-D
Phone: 321-639-9800