MEDICARE: OPEN DOORS BEHAVIORAL CONSULTING 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528765567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN DOORS BEHAVIORAL CONSULTING LLC

Provider Business Mailing Address
First Line	:	3605 BAY TREE RD
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-5660
Country	:	US
Telephone Number	:	850-565-1057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 BAY TREE RD
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-5660
Country	:	US
Telephone Number	:	850-527-2607
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	APRIL LAWHORN
Credential	:	BCBA
Telephone Number	:	850-565-1057

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	04/29/2023

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