Provider Demographics
NPI:1295297406
Name:ONE ON ONE BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:ONE ON ONE BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:305-204-7037
Mailing Address - Street 1:12973 SW 112 ST #151
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4768
Mailing Address - Country:US
Mailing Address - Phone:786-558-6133
Mailing Address - Fax:786-228-2555
Practice Address - Street 1:12973 SW 112 ST #151
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5826
Practice Address - Country:US
Practice Address - Phone:786-558-6133
Practice Address - Fax:786-228-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018395600Medicaid