Provider Demographics
NPI:1538854393
Name:LIBERTY APPLIED BEHAVIOR ANALYSIS
Entity type:Organization
Organization Name:LIBERTY APPLIED BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:254-702-3234
Mailing Address - Street 1:4205 WHITETAIL CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-7112
Mailing Address - Country:US
Mailing Address - Phone:254-702-3234
Mailing Address - Fax:
Practice Address - Street 1:4205 WHITETAIL CIR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-7112
Practice Address - Country:US
Practice Address - Phone:254-702-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty