MEDICARE: GOOD CHOICE TEAM, 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	:	1376051003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD CHOICE TEAM, LLC.

Provider Business Mailing Address
First Line	:	560 VILLAGE BLVD STE 325
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1962
Country	:	US
Telephone Number	:	561-771-9561
Fax Number	:	800-766-3139

Provider Business Practice Location Address
First Line	:	560 VILLAGE BLVD STE 325
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1962
Country	:	US
Telephone Number	:	561-771-9561
Fax Number	:	800-766-3139

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NELSON BONET
Credential	:
Telephone Number	:	786-970-8062

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	01/16/2018

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Directions to “GOOD CHOICE TEAM, LLC. ” Practice Location

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