Healthcare Provider Details

I. General information

NPI: 1285152603
Provider Name (Legal Business Name): NORTHWEST FLORIDA BEHAVIORAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WALNUT AVE
SHALIMAR FL
32579-1120
US

IV. Provider business mailing address

36 WALNUT AVE
SHALIMAR FL
32579-1120
US

V. Phone/Fax

Practice location:
  • Phone: 850-420-2498
  • Fax:
Mailing address:
  • Phone: 850-420-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN LOUISE SELLERS
Title or Position: OWNER
Credential:
Phone: 859-420-2498