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General NPI Number Information
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NPI Number | 1942626643
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Entity Type | Organization
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Legal Business Name | EXCELLERATED TEACHING CENTER, INC.
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 5175 45TH ST N # 4
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City | ST PETERSBURG
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State | FL
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Zip | 33714-2266
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Country | US
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Telephone | 727-748-4060
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Fax | 727-748-4060
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Provider Business Mailing Address
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Address Line | 5175 45TH ST N # 4
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City | ST PETERSBURG
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State | FL
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Zip | 33714-2266
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Country | US
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Telephone | 727-748-4060
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Fax | 727-748-4060
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT JONES HASBROUCK
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Credential |
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Telephone | 727-686-1142
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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 | 0-13-5494
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License Number State | FL
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