Healthcare Provider Details

I. General information

NPI: 1326672932
Provider Name (Legal Business Name): MAKING THE DIFFERENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8237 VICELA DR
SARASOTA FL
34240-1462
US

IV. Provider business mailing address

8237 VICELA DR
SARASOTA FL
34240-1462
US

V. Phone/Fax

Practice location:
  • Phone: 941-342-8811
  • Fax: 941-342-1811
Mailing address:
  • Phone: 419-342-8811
  • Fax: 941-342-1811

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 State

VIII. Authorized Official

Name: MILISSA YEAGLEY
Title or Position: VP OF CLINICAL OPERATIONS
Credential: BCBA
Phone: 321-348-8359