Provider Demographics
NPI:1821530841
Name:ACHIEVE BEHAVIORAL DEVELOPMENT SERVICES
Entity Type:Organization
Organization Name:ACHIEVE BEHAVIORAL DEVELOPMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:MEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:863-670-1900
Mailing Address - Street 1:4060 SUNSET LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2841
Mailing Address - Country:US
Mailing Address - Phone:863-670-1900
Mailing Address - Fax:
Practice Address - Street 1:4060 SUNSET LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2841
Practice Address - Country:US
Practice Address - Phone:863-670-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-17191103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty