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NPI Code Detail

MEDICARE: ATHENA BEHAVIOR CONSULT

MEDICARE: ATHENA BEHAVIOR CONSULT
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1851965271
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATHENA BEHAVIOR CONSULT
Provider Business Mailing Address
First Line : 1219 SE 34TH ST
Second Line :
City : CAPE CORAL
State : FL
Zip : 33904-4291
Country : US
Telephone Number : 239-703-3502
Fax Number : 844-640-0724
Provider Business Practice Location Address
First Line : 1219 SE 34TH ST
Second Line :
City : CAPE CORAL
State : FL
Zip : 33904-4291
Country : US
Telephone Number : 239-703-3502
Fax Number : 844-640-0724
Authorized Official
Title or Position : OWNER
Name : GRISSEL ALFONSO GONZALEZ
Credential :
Telephone Number : 239-703-3502
Provider Enumeration Date : 05/19/2021
Last Update Date : 05/19/2021

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Directions to “ATHENA BEHAVIOR CONSULT ” Practice Location

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