Provider Demographics
NPI:1255864252
Name:PROFESSIONAL TCM & BEHAVIORAL ANALYST SERVICES, CORP
Entity Type:Organization
Organization Name:PROFESSIONAL TCM & BEHAVIORAL ANALYST SERVICES, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RATCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-351-6878
Mailing Address - Street 1:47 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6014
Mailing Address - Country:US
Mailing Address - Phone:786-351-6878
Mailing Address - Fax:786-581-5417
Practice Address - Street 1:47 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6014
Practice Address - Country:US
Practice Address - Phone:786-351-6878
Practice Address - Fax:786-581-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health