Provider Demographics
NPI:1013348176
Name:LYTTLE, ORVILLE (BCBA)
Entity Type:Individual
Prefix:
First Name:ORVILLE
Middle Name:
Last Name:LYTTLE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5152
Mailing Address - Country:US
Mailing Address - Phone:954-987-3201
Mailing Address - Fax:888-889-6290
Practice Address - Street 1:5821 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5152
Practice Address - Country:US
Practice Address - Phone:954-987-3201
Practice Address - Fax:888-889-6290
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1096646103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst