Provider Demographics
NPI:1851965271
Name:ATHENA BEHAVIOR CONSULT
Entity Type:Organization
Organization Name:ATHENA BEHAVIOR CONSULT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRISSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-703-3502
Mailing Address - Street 1:1219 SE 34TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4291
Mailing Address - Country:US
Mailing Address - Phone:239-703-3502
Mailing Address - Fax:844-640-0724
Practice Address - Street 1:1219 SE 34TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-4291
Practice Address - Country:US
Practice Address - Phone:239-703-3502
Practice Address - Fax:844-640-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty