Provider Demographics
NPI:1174785323
Name:PROACTIVE BEHAVIOR SOLUTIONS INCORPORATED
Entity type:Organization
Organization Name:PROACTIVE BEHAVIOR SOLUTIONS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS BCBA
Authorized Official - Phone:727-781-7200
Mailing Address - Street 1:2460 NORTHSIDE DR
Mailing Address - Street 2:APT 1303
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2460 NORTHSIDE DR
Practice Address - Street 2:APT 1303
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2242
Practice Address - Country:US
Practice Address - Phone:727-781-7200
Practice Address - Fax:727-781-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691662796OtherMEDICAID WAIVER
FL691662798OtherMEDICAID WAIVER