MEDICARE: BEHAVIORAL AND LIFE CONNECTIONS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457946238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL AND LIFE CONNECTIONS

Provider Business Mailing Address
First Line	:	PO BOX 5812
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32447-5812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8219 FRONT BEACH RD STE B # 2148
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-4822
Country	:	US
Telephone Number	:	850-427-3079
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DEAUNDRA JACKSON
Credential	:
Telephone Number	:	850-427-3079

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	01/05/2025

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Directions to “BEHAVIORAL AND LIFE CONNECTIONS ” Practice Location

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