Provider Demographics
NPI:1104094838
Name:JUDY PRESLEY
Entity type:Organization
Organization Name:JUDY PRESLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:352-694-7201
Mailing Address - Street 1:3035 NE JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-3311
Mailing Address - Country:US
Mailing Address - Phone:352-694-7201
Mailing Address - Fax:352-694-7581
Practice Address - Street 1:3035 NE JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-3311
Practice Address - Country:US
Practice Address - Phone:352-694-7201
Practice Address - Fax:352-694-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-00-0180251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-00-0180OtherBEHAVIOR ANALYSIS CERT