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General NPI Number Information
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NPI Number | 1134594815
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Entity Type | Organization
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Legal Business Name | POSITIVE BEHAVIOR THERAPY, INC
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 15335 SEAROBBIN DR
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5864
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Country | US
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Telephone | 941-755-1057
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Fax | 941-755-1057
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Provider Business Mailing Address
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Address Line | 15335 SEAROBBIN DR
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5864
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Country | US
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Telephone | 941-755-1057
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Fax | 941-755-1057
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Authorized Official
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Title or Position | PRESIDENT LEAD BEHAVIOR ANALYST
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Name | MR. JOHN NICHOLAS BEHLING
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Credential | BCBA
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Telephone | 941-755-1057
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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 | 1-10-6954
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License Number State | FL
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