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General NPI Number Information
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NPI Number | 1508368192
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Entity Type | Organization
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Legal Business Name | LIVE OAK BEHAVIORAL HEALTH PA
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 341 N MAITLAND AVE STE 120
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City | MAITLAND
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State | FL
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Zip | 32751-4761
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Country | US
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Telephone | 407-756-2084
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Fax | 866-495-2994
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Provider Business Mailing Address
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Address Line | 341 N MAITLAND AVE STE 120
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City | MAITLAND
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State | FL
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Zip | 32751-4761
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Country | US
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Telephone | 407-756-2084
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. DANIEL PAULSON
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Credential | PHD
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Telephone | 407-756-2084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PY9901
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License Number State | FL
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