Provider Demographics
NPI:1922145184
Name:BEHAVIORAL SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-830-6412
Mailing Address - Street 1:801 DOUGLAS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5206
Mailing Address - Country:US
Mailing Address - Phone:407-830-6412
Mailing Address - Fax:407-830-8413
Practice Address - Street 1:801 DOUGLAS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5206
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:407-830-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLGH203251S00000X
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL550531OtherVALUE OPTIONS, MEDICAID
FL678222196Medicaid
FL307161OtherUNITED HMO MEDICAID
FL678222198Medicaid
FL765763300Medicaid
FL272081OtherAMERIGROUP HMO MEDICAID
FL281886OtherHARMONY HMO MEDICAID
FLGH203OtherSTATE SAMH OFFICE