Provider Demographics
NPI:1942538996
Name:EXCEPTIONAL BEHAVIOR
Entity Type:Organization
Organization Name:EXCEPTIONAL BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWOBODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-215-6441
Mailing Address - Street 1:1015B GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2494
Mailing Address - Country:US
Mailing Address - Phone:850-215-6441
Mailing Address - Fax:850-215-6457
Practice Address - Street 1:1015B GRACE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2494
Practice Address - Country:US
Practice Address - Phone:850-215-6441
Practice Address - Fax:850-215-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578767208OtherINDIVIDUAL