Provider Demographics
NPI:1285098756
Name:SMITH, SALLY LEE (BCBA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:DENISE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:6411 SW LEE BAILEY LANDING RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-5613
Mailing Address - Country:US
Mailing Address - Phone:850-372-3729
Mailing Address - Fax:
Practice Address - Street 1:6411 SW LEE BAILEY LANDING RD
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-5613
Practice Address - Country:US
Practice Address - Phone:850-372-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst