| Behavior 180, Llc | |
|
420 E Sr 434 Ste A Longwood FL 32750-5244 | |
| (407) 476-4908 | |
| (844) 839-5839 |
| Full Name | Behavior 180, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 420 E Sr 434 Ste A, Longwood, Florida |
| Authorized Official Name and Position | Kimmesha C Troutman (OWNER) |
| Authorized Official Contact | 4074764908 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavior 180, Llc 420 E Sr 434 Ste A Longwood FL 32750-5244 Ph: (407) 476-4908 | Behavior 180, Llc 420 E Sr 434 Ste A Longwood FL 32750-5244 Ph: (407) 476-4908 |
| NPI Number | 1902365638 |
|---|---|
| Provider Enumeration Date | 03/12/2019 |
| Last Update Date | 12/02/2020 |
| Certification Date | 12/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902365638 | NPI | - | NPPES |
| 017645000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 106S00000X | Behavior Technician | (* (Not Available)) | Secondary |
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