Healthcare Provider Details

I. General information

NPI: 1144716572
Provider Name (Legal Business Name): KRISTI LEE CORLEY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 08/06/2023
Certification Date: 09/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 SE CENTRAL PKWY
STUART FL
34994-3919
US

IV. Provider business mailing address

799 SE CELTIC AVE
PORT ST LUCIE FL
34983-2711
US

V. Phone/Fax

Practice location:
  • Phone: 772-510-2048
  • Fax:
Mailing address:
  • Phone: 772-323-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42039
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: