Provider Demographics
NPI:1124502745
Name:SCULL, CHRISTA (RBT)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:SCULL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 11TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1320
Mailing Address - Country:US
Mailing Address - Phone:866-289-0222
Mailing Address - Fax:727-300-0225
Practice Address - Street 1:7418 10TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5104
Practice Address - Country:US
Practice Address - Phone:727-526-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-65673106S00000X
1-21-54547103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-18-65673OtherBACB
FL1-21-54547OtherBACB