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General NPI Number Information
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NPI Number | 1134599624
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Entity Type | Organization
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Legal Business Name | PANHANDLE BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 09/28/2015
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 1229 AIRPORT RD
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City | PANAMA CITY
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State | FL
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Zip | 32405-3527
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Country | US
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Telephone | 850-215-6770
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Fax | 850-665-0123
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Provider Business Mailing Address
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Address Line | 1229 AIRPORT RD
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City | PANAMA CITY
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State | FL
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Zip | 32405-3527
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Country | US
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Telephone | 850-215-6770
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Fax | 850-665-0123
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Authorized Official
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Title or Position | OWNER/LEAD BEHAVIOR ANALYST
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Name | MR. CHARLES BRENT MARTIN
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Credential | BCBA
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Telephone | 850-326-6937
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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 | 1-10-6993
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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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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