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General NPI Number Information
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NPI Number | 1326585639
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Entity Type | Organization
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Legal Business Name | ONWARD MOMENTUM BEHAVIOR ANALYSIS AND MENTAL WELLNESS SERVICES, LLC
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 350 HOLLYWOOD BLVD SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5772
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Country | US
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Telephone | 850-368-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 350 HOLLYWOOD BLVD SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5772
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Country | US
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Telephone | 850-368-9373
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MELODY RAY
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Credential | BCBA, LMHC, NCC
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Telephone | 850-368-9373
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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 | MH14594
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-16-23681
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License Number State | FL
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