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General NPI Number Information
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NPI Number | 1669152286
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Entity Type | Organization
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Legal Business Name | LIFESTYLE BEHAVIOR LLC
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 1931 NW 150TH AVE STE 223
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2880
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Country | US
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Telephone | 954-406-7278
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Fax | 954-406-7241
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Provider Business Mailing Address
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Address Line | 1931 NW 150TH AVE STE 223
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2880
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Country | US
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Telephone | 954-406-7278
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Fax | 954-406-7241
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Authorized Official
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Title or Position | OWNER
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Name | ANTONIO E GONZALEZ VELEZ
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Credential |
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Telephone | 754-261-0682
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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 |
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License Number State |
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