Provider Demographics
NPI:1154502888
Name:POSITIVE BEHAVIORAL CHANGE INCORPORATED
Entity Type:Organization
Organization Name:POSITIVE BEHAVIORAL CHANGE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MCCALLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-298-8586
Mailing Address - Street 1:4340 NW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2146
Mailing Address - Country:US
Mailing Address - Phone:954-298-8586
Mailing Address - Fax:954-583-1567
Practice Address - Street 1:4431 DAVIE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3458
Practice Address - Country:US
Practice Address - Phone:954-298-8586
Practice Address - Fax:954-583-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7809251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health