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Organization
PBS
Active
Organization
PBS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON BALLINGER (REGIONAL COORDINATOR)
(855) 832-6727
Entity
Organization
Contact information
Practice address
1831 17TH CT N, LAKE WORTH, FL 33460-6437
(855) 832-6727
(772) 675-9100
Mailing address
4575 SE DIXIE HWY, STUART, FL 34997-6826
(855) 832-6727
(772) 675-9100
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/07/2018
Last updated
09/07/2023
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