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General NPI Number Information
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NPI Number | 1942651492
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Entity Type | Organization
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Legal Business Name | EQUIP BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 14728 ROYAL POINCIANA DR
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City | ORLANDO
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State | FL
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Zip | 32828-7329
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Country | US
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Telephone | 407-416-0810
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Fax |
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Provider Business Mailing Address
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Address Line | 14728 ROYAL POINCIANA DR
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City | ORLANDO
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State | FL
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Zip | 32828-7329
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Country | US
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Telephone | 407-416-0810
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Fax |
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Authorized Official
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Title or Position | FOUNDER/BEHAVIOR ANALYST
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Name | MR. OLIVER KARL NOFUENTE
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Credential | M.S.
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Telephone | 407-416-0810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | L16000053079
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License Number State | FL
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