| Blue Wave Behavioral Serivces | |
|
1482 Premier Village Way Fl Usa Clearwater FL 33764-2885 | |
| (727) 278-6765 | |
| Not Available |
| Full Name | Blue Wave Behavioral Serivces |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1482 Premier Village Way Fl Usa, Clearwater, Florida |
| Authorized Official Name and Position | Jennifer Wixon (OWNER) |
| Authorized Official Contact | 7272786765 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Wave Behavioral Serivces 1482 Premier Village Way Fl Usa Clearwater FL 33764-2885 Ph: (727) 278-6765 | Blue Wave Behavioral Serivces 1482 Premier Village Way Fl Usa Clearwater FL 33764-2885 Ph: (727) 278-6765 |
| NPI Number | 1295443224 |
|---|---|
| Provider Enumeration Date | 11/08/2022 |
| Last Update Date | 11/08/2022 |
| Certification Date | 11/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295443224 | NPI | - | NPPES |
| 110767000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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