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Organization
LIVING BY GRACE BT CORP
Active
Organization
LIVING BY GRACE BT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA HERNANDEZ MENDEZ BCBA (AUTHORIZED OFFICIAL)
(786) 560-8559
Entity
Organization
Contact information
Practice address
312 S OLD DIXIE HWY STE 202, JUPITER, FL 33458-7489
(786) 560-8559
Mailing address
312 S OLD DIXIE HWY STE 202, JUPITER, FL 33458-7489
(786) 560-8559
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105309600
—
FL
Enumeration date
10/07/2021
Last updated
05/05/2022
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