Provider Demographics
NPI:1235702341
Name:SYSTEMIC BEHAVIORAL THERAPY LLC
Entity Type:Organization
Organization Name:SYSTEMIC BEHAVIORAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOELY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:FL MT 3158
Authorized Official - Phone:786-697-6201
Mailing Address - Street 1:2180 W FIRST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3221
Mailing Address - Country:US
Mailing Address - Phone:786-697-6201
Mailing Address - Fax:
Practice Address - Street 1:2180 W FIRST ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3221
Practice Address - Country:US
Practice Address - Phone:786-697-6201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty