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General NPI Number Information
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NPI Number | 1780435602
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Entity Type | Organization
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Legal Business Name | FAIRCLOUGH BEHAVIOR SERVICES LLC FL
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 2255 GLADES RD STE 324A
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City | BOCA RATON
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State | FL
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Zip | 33431-8571
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Country | US
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Telephone | 770-608-7317
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Fax | 770-212-3714
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Provider Business Mailing Address
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Address Line | 3852 MIRANDA CT
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City | SUWANEE
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State | GA
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Zip | 30024-8670
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Country | US
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Telephone | 770-608-7317
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Fax | 770-212-3714
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAUN PAUL FAIRCLOUGH
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Credential | BCBA
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Telephone | 770-608-7317
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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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