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General NPI Number Information
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NPI Number | 1104494327
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Entity Type | Organization
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Legal Business Name | BLUEHEART BEHAVIORAL SERVICES FOR KIDS LLC
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 3201 BUDINGER AVE
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City | SAINT CLOUD
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State | FL
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Zip | 34769-7203
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Country | US
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Telephone | 407-498-4079
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Fax | 407-624-5649
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Provider Business Mailing Address
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Address Line | 3201 BUDINGER AVE
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City | SAINT CLOUD
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State | FL
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Zip | 34769-7203
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Country | US
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Telephone | 407-498-4079
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Fax | 407-624-5681
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Authorized Official
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Title or Position | OWNER
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Name | JEANICE GELABERT
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Credential |
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Telephone | 407-624-5649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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