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General NPI Number Information
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NPI Number | 1467810184
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Entity Type | Organization
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Legal Business Name | BRILLIANT CONCEPTS BEHAVIORAL ASSOCIATES
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 1557 PINE MARSH LOOP
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City | SAINT CLOUD
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State | FL
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Zip | 34771-7407
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Country | US
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Telephone | 407-242-4320
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Fax | 407-960-3009
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Provider Business Mailing Address
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Address Line | 1557 PINE MARSH LOOP
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City | SAINT CLOUD
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State | FL
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Zip | 34771-7407
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Country | US
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Telephone | 407-242-4320
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Fax | 407-960-3009
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Authorized Official
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Title or Position | PRESIDENT
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Name | WENDY ZEBALLOS
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Credential | BCBA-D
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Telephone | 407-242-4320
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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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