Provider Demographics
NPI:1528636750
Name:AUTISM BEHAVIOR THERAPY LLC
Entity type:Organization
Organization Name:AUTISM BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:BONNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:689-308-8057
Mailing Address - Street 1:288 MARJORIE BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4627
Mailing Address - Country:US
Mailing Address - Phone:689-308-8057
Mailing Address - Fax:689-215-0653
Practice Address - Street 1:712 SECRET HARBOR LN UNIT 102
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6497
Practice Address - Country:US
Practice Address - Phone:312-351-1803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty