Healthcare Provider Details

I. General information

NPI: 1093661746
Provider Name (Legal Business Name): CITRUS BLOSSOM BEHAVIOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N TEXAS AVE
TAVARES FL
32778-3009
US

IV. Provider business mailing address

324 N TEXAS AVE
TAVARES FL
32778-3009
US

V. Phone/Fax

Practice location:
  • Phone: 407-680-8595
  • Fax:
Mailing address:
  • Phone: 407-680-8595
  • Fax: 407-680-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ALEXIS KRISTINA STAHL
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential:
Phone: 407-680-8595