Organization
ABA LYFE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR DETHEROW (BCBA)
(925) 337-7384
Entity
Organization
Contact information
Practice address
1007 PINEVIEW BLVD UNIT C, FORT WALTON BEACH, FL 32547-1499
(925) 337-7384
Mailing address
1007 PINEVIEW BLVD UNIT C, FORT WALTON BEACH, FL 32547-1499
(925) 337-7384
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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