Provider Demographics
NPI:1326734054
Name:ADVANCED BEHAVIORAL CONSULTS, LLC
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL CONSULTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, QS
Authorized Official - Phone:305-335-4117
Mailing Address - Street 1:3350 SW 148TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3237
Mailing Address - Country:US
Mailing Address - Phone:305-335-4117
Mailing Address - Fax:
Practice Address - Street 1:431 SW 147TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-6101
Practice Address - Country:US
Practice Address - Phone:305-335-4117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty