Provider Demographics
NPI:1568171262
Name:ADAPT & TRANSFORM BEHAVIOR
Entity Type:Organization
Organization Name:ADAPT & TRANSFORM BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RBT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-922-9578
Mailing Address - Street 1:822 PROVIDENCE TRACE CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4076
Mailing Address - Country:US
Mailing Address - Phone:813-922-9578
Mailing Address - Fax:
Practice Address - Street 1:1400 GANDY BLVD N UNIT 204
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2118
Practice Address - Country:US
Practice Address - Phone:727-417-3269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC145176955880Medicaid