Organization
BEHAVIOR 180, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMMESHA C TROUTMAN M.A., BCBA (OWNER)
(407) 476-4908
Entity
Organization
Contact information
Practice address
420 E SR 434 STE A, LONGWOOD, FL 32750-5244
(407) 476-4908
(844) 839-5839
Mailing address
420 E SR 434 STE A, LONGWOOD, FL 32750-5244
(407) 476-4908
(844) 839-5839
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017645000
—
FL
Enumeration date
03/12/2019
Last updated
12/02/2020
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