=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619799764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACHIEVE BEHAVIORAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2024
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 54024 CORLEY DR
-----------------------------------------------------
City | CALLAHAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32011-8679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-547-9914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54024 CORLEY DR
-----------------------------------------------------
City | CALLAHAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32011-8679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-547-9914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AUBREY JONES
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 904-547-9914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------