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General NPI Number Information
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NPI Number | 1609937176
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Entity Type | Organization
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Legal Business Name | AGENCY FOR BEHAVIORAL SERVICES, INC.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 7159 W GROVER CLEVELAND BLVD
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City | HOMOSASSA
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State | FL
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Zip | 34446-1310
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Country | US
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Telephone | 352-621-0502
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Fax | 352-621-0503
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Provider Business Mailing Address
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Address Line | 7159 W GROVER CLEVELAND BLVD
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City | HOMOSASSA
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State | FL
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Zip | 34446-1310
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Country | US
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Telephone | 352-621-0502
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Fax | 352-621-0503
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BOBBI SUGAR GIBSON
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Credential | MA,BCBA
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Telephone | 352-621-0502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-03-1296
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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