Organization
BHAVIORAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESUS L LAGE COMAS (PRESIDENT)
(786) 393-2415
Entity
Organization
Contact information
Practice address
12557 NEW BRITTANY BLVD STE 3V-26, FORT MYERS, FL 33907-3651
(786) 355-4371
Mailing address
12557 NEW BRITTANY BLVD #3, SUITE 3V-26, FORT MYERS, FL 33907-3651
(786) 393-2415
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/18/2022
Last updated
07/19/2022
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