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General NPI Number Information
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NPI Number | 1457946238
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL AND LIFE CONNECTIONS
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 01/05/2025
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Provider Practice Location Address
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Address Line | 8219 FRONT BEACH RD STE B # 2148
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-4822
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Country | US
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Telephone | 850-427-3079
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5812
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City | MARIANNA
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State | FL
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Zip | 32447-5812
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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 | MEMBER
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Name | DEAUNDRA JACKSON
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Credential |
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Telephone | 850-427-3079
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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 |
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License Number State |
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