Provider Demographics
NPI:1780036111
Name:DECOS, BEYCHA M (BCABA #0-16-7544)
Entity Type:Individual
Prefix:
First Name:BEYCHA
Middle Name:M
Last Name:DECOS
Suffix:
Gender:F
Credentials:BCABA #0-16-7544
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 BROOK HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4600
Mailing Address - Country:US
Mailing Address - Phone:407-970-2737
Mailing Address - Fax:
Practice Address - Street 1:809 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5834
Practice Address - Country:US
Practice Address - Phone:407-483-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-16-7544106E00000X, 106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018081100Medicaid