MEDICARE: BRILLIANT CONCEPTS BEHAVIORAL ASSOCIATES

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	:	1467810184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANT CONCEPTS BEHAVIORAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1557 PINE MARSH LOOP
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-7407
Country	:	US
Telephone Number	:	407-242-4320
Fax Number	:	407-960-3009

Provider Business Practice Location Address
First Line	:	1557 PINE MARSH LOOP
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-7407
Country	:	US
Telephone Number	:	407-242-4320
Fax Number	:	407-960-3009

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WENDY ZEBALLOS
Credential	:	BCBA-D
Telephone Number	:	407-242-4320

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	02/09/2016

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