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General NPI Number Information
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NPI Number | 1982145306
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS IN BEHAVIOR, LLC
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Dates
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Enumeration Date | 03/17/2017
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Last Update Date | 04/08/2017
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Provider Practice Location Address
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Address Line | 255 PRIMERA BLVD SUITE 160B
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City | LAKE MARY
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State | FL
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Zip | 32746-2158
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Country | US
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Telephone | 765-776-6668
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Fax |
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Provider Business Mailing Address
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Address Line | 255 PRIMERA BLVD SUITE 160B
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City | LAKE MARY
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State | FL
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Zip | 32746-2158
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Country | US
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Telephone | 765-776-6668
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST/OWNER
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Name | MR. LORNE THOMAS BALMER
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Credential | BCBA
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Telephone | 765-776-6668
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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 | 0-16-7295
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-09-5012
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License Number State |
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