Provider Demographics
NPI:1235459199
Name:ADVANCED BEHAVIORAL CONSULTING, LLC
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-519-4362
Mailing Address - Street 1:4600 NW 41ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4511
Mailing Address - Country:US
Mailing Address - Phone:352-575-0362
Mailing Address - Fax:
Practice Address - Street 1:4600 NW 41ST PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4511
Practice Address - Country:US
Practice Address - Phone:352-575-0362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL004375800251B00000X
FL232841253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004375800Medicaid