Provider Demographics
NPI:1235811688
Name:GOOD LIFE BEHAVIOR CORP
Entity Type:Organization
Organization Name:GOOD LIFE BEHAVIOR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-709-7932
Mailing Address - Street 1:2240 PALM BEACH LAKES BLVD STE 400L
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3410
Mailing Address - Country:US
Mailing Address - Phone:786-709-7932
Mailing Address - Fax:
Practice Address - Street 1:2240 PALM BEACH LAKES BLVD STE 400L
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3410
Practice Address - Country:US
Practice Address - Phone:786-709-7932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty