Provider Demographics
NPI:1164204814
Name:GENESIS BEHAVIORAL SERVICES AND CONSULTING INC
Entity Type:Organization
Organization Name:GENESIS BEHAVIORAL SERVICES AND CONSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENESIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:PRUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-348-6085
Mailing Address - Street 1:7520 S ARAGON BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-8087
Mailing Address - Country:US
Mailing Address - Phone:786-348-6085
Mailing Address - Fax:
Practice Address - Street 1:7520 S ARAGON BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-8087
Practice Address - Country:US
Practice Address - Phone:786-348-6085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty