Healthcare Provider Details

I. General information

NPI: 1013422724
Provider Name (Legal Business Name): GAIN BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 MILNE BLVD
NEW ORLEANS LA
70124-1829
US

IV. Provider business mailing address

5655 MILNE BLVD
NEW ORLEANS LA
70124-1829
US

V. Phone/Fax

Practice location:
  • Phone: 727-599-9912
  • Fax:
Mailing address:
  • Phone: 727-599-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACOB PAUL SIMON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 727-599-9912