| Full Spectrum Behavioral Analysis Llc | |
|
16414 Lake Church Dr Odessa FL 33556-2637 | |
| (813) 205-2715 | |
| (813) 920-9252 |
| Full Name | Full Spectrum Behavioral Analysis Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 16414 Lake Church Dr, Odessa, Florida |
| Authorized Official Name and Position | Carroll Edward Streetman (PRESIDENT) |
| Authorized Official Contact | 8132052715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Spectrum Behavioral Analysis Llc 16414 Lake Church Dr Odessa FL 33556-2637 Ph: (813) 205-2715 | Full Spectrum Behavioral Analysis Llc 16414 Lake Church Dr Odessa FL 33556-2637 Ph: (813) 205-2715 |
| NPI Number | 1174928931 |
|---|---|
| Provider Enumeration Date | 10/22/2014 |
| Last Update Date | 11/24/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174928931 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-14-15276 (* (Not Available)) | Primary |
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