Provider Demographics
NPI:1760085518
Name:LEADERS BEHAVIOR ABA & COUNSELING, LLC
Entity Type:Organization
Organization Name:LEADERS BEHAVIOR ABA & COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:YANED
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:772-777-9265
Mailing Address - Street 1:1600 SW SYLVESTER LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3605
Mailing Address - Country:US
Mailing Address - Phone:772-777-9265
Mailing Address - Fax:
Practice Address - Street 1:1600 SW SYLVESTER LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-3605
Practice Address - Country:US
Practice Address - Phone:772-777-9265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty