Provider Demographics
NPI:1780754747
Name:COACHING BEHAVIORAL ALTERNATIVES INC
Entity type:Organization
Organization Name:COACHING BEHAVIORAL ALTERNATIVES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, BCBA
Authorized Official - Phone:386-253-4131
Mailing Address - Street 1:615 RIVERVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-3840
Mailing Address - Country:US
Mailing Address - Phone:386-253-4131
Mailing Address - Fax:386-947-9607
Practice Address - Street 1:615 RIVERVIEW BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-3840
Practice Address - Country:US
Practice Address - Phone:386-253-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686939498Medicaid
FL686939496Medicaid