Provider Demographics
NPI:1770255895
Name:FLOYD, MAHOGONY BRIANA (RBT)
Entity Type:Individual
Prefix:
First Name:MAHOGONY
Middle Name:BRIANA
Last Name:FLOYD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14539 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-1234
Mailing Address - Country:US
Mailing Address - Phone:630-294-3715
Mailing Address - Fax:
Practice Address - Street 1:9500 BORMET DR STE 201
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8399
Practice Address - Country:US
Practice Address - Phone:630-294-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician