Organization
BEHAVIOR ANALYSIS SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT POTAK MS, BCBA (PRESIDENT)
(727) 504-6539
Entity
Organization
Contact information
Practice address
692 GREENGLEN LN, PALM HARBOR, FL 34684-3024
(727) 504-6539
(727) 322-9839
Mailing address
692 GREENGLEN LN, PALM HARBOR, FL 34684-3024
(727) 504-6539
(727) 322-9839
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
686457196
MEDICAID WAIVER
FL
Enumeration date
12/29/2010
Last updated
12/29/2010
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