MEDICARE: SOUTH BARRETT BEHAVIORAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1285528356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BARRETT BEHAVIORAL LLC

Provider Business Mailing Address
First Line	:	331 TURTLE CV
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-8441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	331 TURTLE CV
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-8441
Country	:	US
Telephone Number	:	904-708-3946
Fax Number	:

Authorized Official
Title or Position	:	OWNER/BCBA
Name	:	AUDREY HILL
Credential	:	BCBA
Telephone Number	:	904-708-3946

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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