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General NPI Number Information
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NPI Number | 1215641022
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL INDEPENDENCE
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 3520 CUMBERLIN CT
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City | TITUSVILLE
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State | FL
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Zip | 32780-5106
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Country | US
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Telephone | 321-522-9949
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 CUMBERLIN CT
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City | TITUSVILLE
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State | FL
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Zip | 32780-5106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HEAD SUPERVISOR
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Name | MRS. AMANDA LANG
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Credential | BCBA
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Telephone | 386-562-0170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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