Provider Demographics
NPI:1568077758
Name:BEHAVIOR MIRACLES LLC
Entity Type:Organization
Organization Name:BEHAVIOR MIRACLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:716-553-8487
Mailing Address - Street 1:8509 SOUTHWIND BAY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6033
Mailing Address - Country:US
Mailing Address - Phone:716-553-8487
Mailing Address - Fax:
Practice Address - Street 1:8509 SOUTHWIND BAY CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6033
Practice Address - Country:US
Practice Address - Phone:716-553-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty