Provider Demographics
NPI:1538423595
Name:ATTENTION BEHAVIOR COGNITIVE THERAPY CLINIC
Entity type:Organization
Organization Name:ATTENTION BEHAVIOR COGNITIVE THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD
Authorized Official - Phone:305-600-0651
Mailing Address - Street 1:45 NW 8TH ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4452
Mailing Address - Country:US
Mailing Address - Phone:305-600-0651
Mailing Address - Fax:800-952-2030
Practice Address - Street 1:5720 SW 195TH TER
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33332-1204
Practice Address - Country:US
Practice Address - Phone:954-775-5013
Practice Address - Fax:800-952-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4876103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty