Provider Demographics
NPI:1225798796
Name:POSITIVE BEHAVIORAL OUTCOMES INC
Entity Type:Organization
Organization Name:POSITIVE BEHAVIORAL OUTCOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERMILLERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-446-0809
Mailing Address - Street 1:1802 S FISKE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3007
Mailing Address - Country:US
Mailing Address - Phone:321-446-0809
Mailing Address - Fax:321-241-4605
Practice Address - Street 1:1802 S FISKE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3007
Practice Address - Country:US
Practice Address - Phone:321-446-0809
Practice Address - Fax:321-241-4605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POSITIVE BEHAVIORAL OUTCOMES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-21-47877Other103K00000X