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General NPI Number Information
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NPI Number | 1639793326
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL CLINICIANS, LLC
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 2650 BAHIA VISTA ST STE 209
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City | SARASOTA
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State | FL
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Zip | 34239-2625
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Country | US
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Telephone | 941-870-3600
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Fax | 727-998-8401
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Provider Business Mailing Address
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Address Line | 20 MEADOWBROOK LN
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City | PALMER
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State | MA
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Zip | 01069-1134
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Country | US
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Telephone | 941-870-3600
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Fax | 727-998-8401
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ADAIR LYNNE DEICKE
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Credential | PMHNP-BC
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Telephone | 727-239-9938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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