Provider Demographics
NPI:1689402166
Name:BEHAVIOR PROFESSIONAL THERAPY
Entity type:Organization
Organization Name:BEHAVIOR PROFESSIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JADY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-833-3939
Mailing Address - Street 1:25200 SAWYER FRANCIS LN STE 119
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-6947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:813-489-4870
Practice Address - Street 1:25200 SAWYER FRANCIS LN STE 119
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-6947
Practice Address - Country:US
Practice Address - Phone:813-400-2401
Practice Address - Fax:813-489-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health