Provider Demographics
NPI:1043899396
Name:PRACTICAL BEHAVIOR SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PRACTICAL BEHAVIOR SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:352-342-5006
Mailing Address - Street 1:10424 SE 174TH PL
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-6963
Mailing Address - Country:US
Mailing Address - Phone:352-342-5006
Mailing Address - Fax:352-245-0766
Practice Address - Street 1:11808 N OHIO ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-6724
Practice Address - Country:US
Practice Address - Phone:352-462-7021
Practice Address - Fax:844-921-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108464700Medicaid