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General NPI Number Information
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NPI Number | 1770427007
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Entity Type | Organization
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Legal Business Name | EVERGREEN TREE ABA CORP
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 5100 W FL-40 SUITE 100 OFFICE 26
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City | OCALA
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State | FL
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Zip | 34482
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Country | US
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Telephone | 954-812-5912
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 W FL-40 SUITE 100 OFFICE 26
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City | OCALA
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State | FL
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Zip | 34482
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Country | US
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Telephone | 954-812-5912
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATALIA FONSECA
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Credential |
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Telephone | 954-812-1305
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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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