Provider Demographics
NPI:1689248643
Name:CHELSEY SAMPLEY, LLC
Entity Type:Organization
Organization Name:CHELSEY SAMPLEY, LLC
Other - Org Name:SUNNY BAY ABA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SAMPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:813-550-8055
Mailing Address - Street 1:1735 MARYLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3323
Mailing Address - Country:US
Mailing Address - Phone:813-550-8055
Mailing Address - Fax:727-623-0490
Practice Address - Street 1:1735 MARYLAND AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3323
Practice Address - Country:US
Practice Address - Phone:813-550-8055
Practice Address - Fax:727-623-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty