Provider Demographics
NPI:1609937176
Name:AGENCY FOR BEHAVIORAL SERVICES, INC.
Entity Type:Organization
Organization Name:AGENCY FOR BEHAVIORAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:SUGAR
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA,BCBA
Authorized Official - Phone:352-621-0502
Mailing Address - Street 1:7159 W GROVER CLEVELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-1310
Mailing Address - Country:US
Mailing Address - Phone:352-621-0502
Mailing Address - Fax:352-621-0503
Practice Address - Street 1:7159 W GROVER CLEVELAND BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-1310
Practice Address - Country:US
Practice Address - Phone:352-621-0502
Practice Address - Fax:352-621-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
FL1-03-1296251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health