Healthcare Provider Details

I. General information

NPI: 1467810184
Provider Name (Legal Business Name): BRILLIANT CONCEPTS BEHAVIORAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 PINE MARSH LOOP
SAINT CLOUD FL
34771-7407
US

IV. Provider business mailing address

1557 PINE MARSH LOOP
SAINT CLOUD FL
34771-7407
US

V. Phone/Fax

Practice location:
  • Phone: 407-242-4320
  • Fax: 407-960-3009
Mailing address:
  • Phone: 407-242-4320
  • Fax: 407-960-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: WENDY ZEBALLOS
Title or Position: PRESIDENT
Credential: BCBA-D
Phone: 407-242-4320