Provider Demographics
NPI:1326585639
Name:ONWARD MOMENTUM BEHAVIOR ANALYSIS AND MENTAL WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:ONWARD MOMENTUM BEHAVIOR ANALYSIS AND MENTAL WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LMHC, NCC
Authorized Official - Phone:850-368-9373
Mailing Address - Street 1:350 HOLLYWOOD BLVD SE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5772
Mailing Address - Country:US
Mailing Address - Phone:850-368-9373
Mailing Address - Fax:
Practice Address - Street 1:350 HOLLYWOOD BLVD SE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5772
Practice Address - Country:US
Practice Address - Phone:850-368-9373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-23681251S00000X
FLMH14594251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health