Provider Demographics
NPI:1922376797
Name:BREE, JORDYNN (BCABA)
Entity Type:Individual
Prefix:
First Name:JORDYNN
Middle Name:
Last Name:BREE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32540-1646
Mailing Address - Country:US
Mailing Address - Phone:850-837-1200
Mailing Address - Fax:850-837-1254
Practice Address - Street 1:4010 COMMONS DR W STE 100
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8421
Practice Address - Country:US
Practice Address - Phone:850-837-1200
Practice Address - Fax:850-837-1254
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-11-4330103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst