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General NPI Number Information
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NPI Number | 1124610464
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Entity Type | Organization
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Legal Business Name | PRESTIGE ABA SERVICES LLC
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 4350 FOWLER ST STE 3
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City | FORT MYERS
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State | FL
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Zip | 33901-2616
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Country | US
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Telephone | 786-317-0100
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Fax | 813-776-1620
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Provider Business Mailing Address
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Address Line | 4350 FOWLER ST STE 3
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City | FORT MYERS
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State | FL
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Zip | 33901-2616
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Country | US
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Telephone | 786-317-0100
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Fax | 813-776-1620
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Authorized Official
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Title or Position | OWNER
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Name | MAIRELYS CONCEPCION
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Credential | RBT
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Telephone | 786-317-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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