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General NPI Number Information
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NPI Number | 1366977910
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Entity Type | Individual
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Provider Name | CHELSEA LYNN PHILLIPS-PAYNE BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 903 LAKE LILY DR APT A122
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 502-612-3474
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Fax |
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Provider Business Mailing Address
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Address Line | 903 LAKE LILY DR APT A122
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City | MAITLAND
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State | FL
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Zip | 32751-7606
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Country | US
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Telephone | 502-612-3474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-27384
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License Number State | CO
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