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General NPI Number Information
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NPI Number | 1659774842
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Entity Type | Organization
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Legal Business Name | APPLIED VERBAL AND BEHAVIORAL ANALYSIS
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 154 TOPSAIL DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-4400
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Country | US
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Telephone | 904-425-9121
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Fax | 888-397-0157
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Provider Business Mailing Address
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Address Line | 154 TOPSAIL DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-4400
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Country | US
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Telephone | 904-425-9121
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Fax | 888-397-0157
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Authorized Official
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Title or Position | OWNER, EXECUTIVE DIRECTOR
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Name | MRS. JANELLE M GLOVA
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Credential | BCBA
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Telephone | 904-425-9121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-12871
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License Number State | FL
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