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General NPI Number Information
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NPI Number | 1316334824
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Entity Type | Organization
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Legal Business Name | BEHAVIOR SUPPORT SERVICES
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 2524 CAPER LN APT 204
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City | MAITLAND
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State | FL
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Zip | 32751-6027
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Country | US
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Telephone | 407-937-8456
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Fax |
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Provider Business Mailing Address
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Address Line | 801 DOUGLAS AVE
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-5206
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Country | US
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Telephone | 407-335-4787
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Fax |
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Authorized Official
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Title or Position | PSYCHO REHABILITIION SPECIALIST
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Name | ROLANDO FOURCAND
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Credential |
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Telephone | 407-937-8456
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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 | FL
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