=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841670411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY TREE BEHAVIORAL CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2015
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1268 11TH ST UNIT 2103
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34236-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-404-3721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2161
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34230-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-404-3721
-----------------------------------------------------
Fax | 941-296-7285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, OWNER
-----------------------------------------------------
Name | DR. KATHRYN E JANN
-----------------------------------------------------
Credential | PH.D., BCBA-D
-----------------------------------------------------
Telephone | 239-218-0627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------