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General NPI Number Information
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NPI Number | 1720457542
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Entity Type | Organization
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Legal Business Name | LIFE SKILLS KID THERAPY INC.
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 1411 SAWGRASS CORPORATE PKWY SUITE B20
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City | SUNRISE
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State | FL
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Zip | 33323-2888
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Country | US
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Telephone | 954-237-1903
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Fax | 888-557-6906
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Provider Business Mailing Address
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Address Line | 1411 SAWGRASS CORPORATE PKWY SUITE B20
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City | SUNRISE
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State | FL
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Zip | 33323-2888
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Country | US
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Telephone | 954-237-1903
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Fax | 888-557-6906
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Authorized Official
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Title or Position | CEO
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Name | BRIAN NEBLETT
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Credential | RN
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Telephone | 305-910-3247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 |
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License Number State |
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