=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629779939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JECHOLIAH STEPHENSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2023
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2895 HUELAND POND BLVD STE 200
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33543-7505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-903-1955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4620 N STATE ROAD 7 STE 300
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-5867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-323-6593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-25-84183
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------