# PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881216877
- **Authorized official:** DR. NICOLE M WOLLER PHD, LCSW (PRESIDENT)
- **Authorized official phone:** (561) 706-1004

## Contact information

- **Practice address:** 5818 SE AGNEW RD, BELLEVIEW, FL 34420-4020
- **Practice address phone:** (561) 706-1004
- **Practice address fax:** (561) 892-0268
- **Mailing address:** 2735 SE 140TH PL, SUMMERFIELD, FL 34491-2877
- **Mailing address phone:** (561) 706-1004
- **Mailing address fax:** (561) 892-0268

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 05/12/2020
- **Last updated:** 03/20/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 102843600 | — | FL |