=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629982673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIOR BRIDGE OF THE HIGHLANDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2026
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2481 STATE ROAD 17 S
-----------------------------------------------------
City | AVON PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33825-8315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-273-0566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2481 STATE ROAD 17 S
-----------------------------------------------------
City | AVON PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33825-8315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-273-0566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LENISA R RAGOODIAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-273-0566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------