Provider Demographics
NPI:1134741218
Name:ADVANCED BEHAVIORAL CLINICIANS
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL CLINICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADAIR
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DEICKE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:941-870-3600
Mailing Address - Street 1:2740 COCONUT BAY LN UNIT 3G
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3055
Mailing Address - Country:US
Mailing Address - Phone:941-870-3600
Mailing Address - Fax:727-998-8401
Practice Address - Street 1:2740 COCONUT BAY LN UNIT 3G
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3055
Practice Address - Country:US
Practice Address - Phone:941-870-3600
Practice Address - Fax:727-998-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty