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General NPI Number Information
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NPI Number | 1134741218
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL CLINICIANS
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 2740 COCONUT BAY LN UNIT 3G
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City | SARASOTA
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State | FL
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Zip | 34237-3055
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Country | US
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Telephone | 941-870-3600
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Fax | 727-998-8401
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Provider Business Mailing Address
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Address Line | 2740 COCONUT BAY LN UNIT 3G
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City | SARASOTA
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State | FL
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Zip | 34237-3055
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Country | US
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Telephone | 941-870-3600
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Fax | 727-998-8401
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. ADAIR LYNNE DEICKE
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Credential | APRN, PMHNP-BC
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Telephone | 941-870-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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