Provider Demographics
NPI:1174884134
Name:APPLIED BEHAVIOR APPROACHES OF TAMPA BAY INC
Entity type:Organization
Organization Name:APPLIED BEHAVIOR APPROACHES OF TAMPA BAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; BOARD CERTIFIED BEHAVIOR ANA
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:DEHAINAUT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:727-241-0246
Mailing Address - Street 1:1353 LOTUS PATH
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-241-0246
Mailing Address - Fax:727-240-4720
Practice Address - Street 1:18946 NORTH DALE MABRY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548
Practice Address - Country:US
Practice Address - Phone:727-241-0246
Practice Address - Fax:727-240-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL1-09-5814251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017420700Medicaid