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General NPI Number Information
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NPI Number | 1528995685
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Entity Type | Organization
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Legal Business Name | VIVID BEHAVIOR SOLUTIONS
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 1617 CHAMPAGNE AVE
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City | GULF BREEZE
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State | FL
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Zip | 32563-9039
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Country | US
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Telephone | 850-384-1131
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Fax |
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Provider Business Mailing Address
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Address Line | 1617 CHAMPAGNE AVE
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City | GULF BREEZE
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State | FL
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Zip | 32563-9039
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Country | US
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Telephone | 850-384-1131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA LEE BASS
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Credential | BCBA
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Telephone | 850-384-1131
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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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