Provider Demographics
NPI:1457196420
Name:MO BEHAVIOR THERAPY LLC
Entity type:Organization
Organization Name:MO BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA LOSADA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:305-795-0600
Mailing Address - Street 1:130 S INDIAN RIVER DR STE 237
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4353
Mailing Address - Country:US
Mailing Address - Phone:305-795-0600
Mailing Address - Fax:
Practice Address - Street 1:130 S INDIAN RIVER DR STE 237
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4353
Practice Address - Country:US
Practice Address - Phone:305-795-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health