Organization
BEHAVIOR COACH, PLLC
Active
Parent organization
BEHAVIOR COACH, PLLC
Other names
Behavior Coach, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEHAVIOR COACH, PLLC
Authorized official
JACQUELINE NEYSA BUCKLE M.S. (OWNER)
(727) 389-1667
Entity
Organization
Contact information
Practice address
3825 HENDERSON BLVD STE 401, TAMPA, FL 33629-5022
(727) 389-1667
Mailing address
12100 INFINITY DR, NEW PORT RICHEY, FL 34654-2040
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487635520
—
FL
Enumeration date
06/19/2019
Last updated
06/19/2019
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