Provider Demographics
NPI:1598254179
Name:WAVES BEHAVIORAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:WAVES BEHAVIORAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:ASHLEE
Authorized Official - Last Name:BEWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:727-348-2532
Mailing Address - Street 1:PO BOX 7606
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33758-7606
Mailing Address - Country:US
Mailing Address - Phone:727-641-0218
Mailing Address - Fax:
Practice Address - Street 1:1258 W BAY DR STE F
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2240
Practice Address - Country:US
Practice Address - Phone:727-641-0218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101881900Medicaid
FL019719700Medicaid