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General NPI Number Information
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NPI Number | 1144844119
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Entity Type | Organization
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Legal Business Name | IMPACT BEHAVIOR SUPPORTS, INC
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 1016 E NORTH BLVD
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City | LEESBURG
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State | FL
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Zip | 34748-5348
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Country | US
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Telephone | 352-874-2986
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 E NORTH BLVD
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City | LEESBURG
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State | FL
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Zip | 34748-5348
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Country | US
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Telephone | 352-874-2986
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS JOCELYN MITCHELL
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Credential | BCBA
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Telephone | 352-874-2986
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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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