=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619698438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCEPTIONAL CHILDRENS BEHAVIORAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2022
-----------------------------------------------------
Last Update Date | 09/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 159 COLUMBIA DR
-----------------------------------------------------
City | POINCIANA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34759-5961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-846-9395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 COLUMBIA DR
-----------------------------------------------------
City | POINCIANA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34759-5961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FRANCISCO J TORRES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-846-9396
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------