Healthcare Provider Details

I. General information

NPI: 1629349048
Provider Name (Legal Business Name): MP BEHAVIORAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 LAKE POINT DR
WESTON FL
33326-2356
US

IV. Provider business mailing address

1925 LAKE POINT DR
WESTON FL
33326-2356
US

V. Phone/Fax

Practice location:
  • Phone: 954-401-2024
  • Fax:
Mailing address:
  • Phone: 954-401-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-01-0302
License Number StateFL

VIII. Authorized Official

Name: MRS. MARIA J. PRESTON
Title or Position: BEHAVIOR ANALYST
Credential: M.S. ED,. BCABA
Phone: 954-401-2024