Provider Demographics
NPI:1336859545
Name:BEHAVIOR LAND INC
Entity Type:Organization
Organization Name:BEHAVIOR LAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PERAZA GOICOLEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-772-5091
Mailing Address - Street 1:14996 SW 283RD ST APT 307
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1154
Mailing Address - Country:US
Mailing Address - Phone:305-772-5091
Mailing Address - Fax:
Practice Address - Street 1:14996 SW 283RD ST APT 307
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1154
Practice Address - Country:US
Practice Address - Phone:305-772-5091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty