Provider Demographics
NPI:1710630728
Name:YOFI BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:YOFI BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:WLODAWSKI
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:863-712-1863
Mailing Address - Street 1:1544 CORDGRASS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2715
Mailing Address - Country:US
Mailing Address - Phone:863-712-1863
Mailing Address - Fax:
Practice Address - Street 1:600 LAKE HOLLINGSWORTH DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2364
Practice Address - Country:US
Practice Address - Phone:863-712-1863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019725100Medicaid