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General NPI Number Information
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NPI Number | 1013423201
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Entity Type | Organization
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Legal Business Name | PINNACLE BEHAVIOR THERAPY, LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 8539 GATE PKWY W UNIT 9311
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1040
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Country | US
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Telephone | 904-600-4664
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Fax |
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Provider Business Mailing Address
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Address Line | 8539 GATE PKWY W UNIT 9311
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1040
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | NINA DEESE
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Credential | BCBA
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Telephone | 904-600-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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