Organization
GULFPORT PREMIER ABA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY STANFORD BCBS, LBA (CO-OWNER)
(228) 229-8297
Entity
Organization
Contact information
Practice address
928 COURTHOUSE RD UNIT 3, GULFPORT, MS 39507-4110
(228) 229-8297
Mailing address
928 COURTHOUSE RD UNIT 3, GULFPORT, MS 39507-4110
(228) 229-8297
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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