Provider Demographics
NPI:1063141604
Name:JOURNEY ABA FLORIDA LLC
Entity type:Organization
Organization Name:JOURNEY ABA FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-798-1253
Mailing Address - Street 1:737 MAIN STREET
Mailing Address - Street 2:STE 100 PMB 33
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695
Mailing Address - Country:US
Mailing Address - Phone:727-213-8851
Mailing Address - Fax:727-231-9795
Practice Address - Street 1:737 MAIN STREET
Practice Address - Street 2:STE 100 PMB 33
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3502
Practice Address - Country:US
Practice Address - Phone:727-213-8851
Practice Address - Fax:727-231-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty