Provider Demographics
NPI:1760627905
Name:APPLIED BEHAVIORAL LEARNING EXPERIENCES, INC
Entity Type:Organization
Organization Name:APPLIED BEHAVIORAL LEARNING EXPERIENCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:OSMON
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, BCBA
Authorized Official - Phone:863-581-1583
Mailing Address - Street 1:PO BOX 2112
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33806-2112
Mailing Address - Country:US
Mailing Address - Phone:863-581-1583
Mailing Address - Fax:863-644-9590
Practice Address - Street 1:454 W PIPKIN RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2545
Practice Address - Country:US
Practice Address - Phone:863-619-2809
Practice Address - Fax:863-646-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017634700Medicaid
FL687700196Medicaid