Provider Demographics
NPI:1760923437
Name:BEHAVIOR MODIFICATION SOLUTIONS ABA, LLC
Entity type:Organization
Organization Name:BEHAVIOR MODIFICATION SOLUTIONS ABA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEARSON
Authorized Official - Middle Name:FOSS
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:956-454-8539
Mailing Address - Street 1:2912 SW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3364
Mailing Address - Country:US
Mailing Address - Phone:956-454-8539
Mailing Address - Fax:
Practice Address - Street 1:2912 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3364
Practice Address - Country:US
Practice Address - Phone:956-454-8539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019932300Medicaid