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General NPI Number Information
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NPI Number | 1649782228
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Entity Type | Individual
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Provider Name | ELIZABETH SHEALY POPE
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Gender | Female
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 303 S BONITA AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3961
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Country | US
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Telephone | 850-381-4462
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Fax |
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Provider Business Mailing Address
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Address Line | 4575 SE DIXIE HWY
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City | STUART
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State | FL
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Zip | 34997-6826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-38276
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License Number State |
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