Organization
BLUE WAVE BEHAVIORAL SERIVCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER WIXON BCBA (OWNER)
(727) 278-6765
Entity
Organization
Contact information
Practice address
1482 PREMIER VILLAGE WAY FL USA, CLEARWATER, FL 33764-2885
(727) 278-6765
Mailing address
1482 PREMIER VILLAGE WAY FL USA, CLEARWATER, FL 33764-2885
(727) 278-6765
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110767000
—
FL
Enumeration date
11/08/2022
Last updated
11/08/2022
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