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111 Nature Walk Pkwy Unit 108 St Augustine FL 32092-3065 | |
| (904) 729-6759 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 111 Nature Walk Pkwy Unit 108, St Augustine, Florida |
| Authorized Official Name and Position | Sarah Lively (OWNER & MANAGER) |
| Authorized Official Contact | 9047296759 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
111 Nature Walk Pkwy Unit 108 St Augustine FL 32092-3065 Ph: (904) 729-6759 | 111 Nature Walk Pkwy Unit 108 St Augustine FL 32092-3065 Ph: (904) 729-6759 |
| NPI Number | 1932980521 |
|---|---|
| Provider Enumeration Date | 10/10/2023 |
| Last Update Date | 11/01/2023 |
| Certification Date | 11/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932980521 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 106S00000X | Behavior Technician | (* (Not Available)) | Secondary |
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