Provider Demographics
NPI:1194020172
Name:DAGNAN BEHAVIORAL CONSULTANTS
Entity Type:Organization
Organization Name:DAGNAN BEHAVIORAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:239-822-6886
Mailing Address - Street 1:13332 QUEEN PALM RUN
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-5294
Mailing Address - Country:US
Mailing Address - Phone:239-822-6886
Mailing Address - Fax:
Practice Address - Street 1:13332 QUEEN PALM RUN
Practice Address - Street 2:
Practice Address - City:N FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-5294
Practice Address - Country:US
Practice Address - Phone:239-822-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1010546251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687169198Medicaid
FL687169196Medicaid