MEDICARE: GULF COAST CHILDREN THERAPIES 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1972307122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST CHILDREN THERAPIES LLC

Provider Business Mailing Address
First Line	:	3949 EVANS AVE STE 401B
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9345
Country	:	US
Telephone Number	:	305-527-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 NE 1ST AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-4226
Country	:	US
Telephone Number	:	305-527-5636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YENIBET HERNANDEZ BETANCOURT
Credential	:
Telephone Number	:	305-527-5636

Provider Enumeration Date	:	04/04/2025
Last Update Date	:	12/17/2025

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