Provider Demographics
NPI:1184598518
Name:WILLOW PATH ABA & LEARNING LC
Entity type:Organization
Organization Name:WILLOW PATH ABA & LEARNING LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA/LBA
Authorized Official - Phone:689-326-7019
Mailing Address - Street 1:626 N ALAFAYA TRL STE 206
Mailing Address - Street 2:PMB1014
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:626 N ALAFAYA TRL STE 206
Practice Address - Street 2:PMB1014
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4353
Practice Address - Country:US
Practice Address - Phone:689-326-7019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-30
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health