Healthcare Provider Details

I. General information

NPI: 1932980521
Provider Name (Legal Business Name): HONEY PEDIATRIC BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NATURE WALK PKWY UNIT 108
ST AUGUSTINE FL
32092-3065
US

IV. Provider business mailing address

111 NATURE WALK PKWY UNIT 108
ST AUGUSTINE FL
32092-3065
US

V. Phone/Fax

Practice location:
  • Phone: 904-729-6759
  • Fax:
Mailing address:
  • Phone: 904-729-6759
  • Fax: 904-490-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: SARAH LIVELY
Title or Position: OWNER & MANAGER
Credential: CCC-SLP
Phone: 904-729-6759