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General NPI Number Information
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NPI Number | 1912442849
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Entity Type | Organization
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Legal Business Name | AMERICAN BEHAVIORAL CONSULTING LLC
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Dates
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Enumeration Date | 01/02/2017
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 11820 MUNBURY DR
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City | DADE CITY
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State | FL
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Zip | 33525-5747
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Country | US
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Telephone | 352-999-0447
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 623
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City | SAN ANTONIO
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State | FL
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Zip | 33576-0623
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Country | US
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Telephone | 352-999-0447
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Fax |
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Authorized Official
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Title or Position | OWNER, BCBA
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Name | JACKALYNNE DELONG
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Credential | M.A., BCBA
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Telephone | 352-999-0447
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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 | 1-16-21952
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License Number State | FL
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