Healthcare Provider Details

I. General information

NPI: 1164138277
Provider Name (Legal Business Name): MISS B'S BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 9TH ST SW
VERO BEACH FL
32962-4311
US

IV. Provider business mailing address

4736 34TH AVE
VERO BEACH FL
32967-1234
US

V. Phone/Fax

Practice location:
  • Phone: 772-713-4130
  • Fax:
Mailing address:
  • Phone: 772-584-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LATOYA M. BULLARD
Title or Position: CEO
Credential: BA
Phone: 772-713-4130