Provider Demographics
NPI:1891968806
Name:POWELL, LEZLEE (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:LEZLEE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3070
Mailing Address - Country:US
Mailing Address - Phone:813-857-4206
Mailing Address - Fax:813-765-6304
Practice Address - Street 1:702 SUNSET RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3070
Practice Address - Country:US
Practice Address - Phone:813-857-4206
Practice Address - Fax:813-765-6304
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X
FL1-12-11369103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019792300Medicaid
FL1891968806OtherBEHAVIOR THERAPEUTIC SOLUTIONS