MEDICARE: TREE OF LIFE BEHAVIORAL SOLUTIONS, CORP

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	:	1649888082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE OF LIFE BEHAVIORAL SOLUTIONS, CORP

Provider Business Mailing Address
First Line	:	1070 MANOR DR
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2947
Country	:	US
Telephone Number	:	786-337-3708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 MANOR DR
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2947
Country	:	US
Telephone Number	:	786-337-3708
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAILYN LOPEZ OLIVERA
Credential	:
Telephone Number	:	786-337-3708

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	07/22/2020

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