Provider Demographics
NPI:1508267980
Name:BEHAVIORAL PROGRESSION, INC
Entity Type:Organization
Organization Name:BEHAVIORAL PROGRESSION, INC
Other - Org Name:NICOLE MINARD, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:863-602-0698
Mailing Address - Street 1:1284 DEVIN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2383
Mailing Address - Country:US
Mailing Address - Phone:863-602-0698
Mailing Address - Fax:813-354-2715
Practice Address - Street 1:1284 DEVIN OAKS CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2383
Practice Address - Country:US
Practice Address - Phone:863-602-0698
Practice Address - Fax:813-354-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL1-14-15928251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014690000Medicaid
FL018166500Medicaid