Provider Demographics
NPI:1558015388
Name:BUILDING BLOCKS APPLIED BEHAVIORAL SERVICES INC
Entity type:Organization
Organization Name:BUILDING BLOCKS APPLIED BEHAVIORAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:813-906-6203
Mailing Address - Street 1:4670 LIPSCOMB ST NE STE 10
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2927
Mailing Address - Country:US
Mailing Address - Phone:813-906-6203
Mailing Address - Fax:813-436-5623
Practice Address - Street 1:4670 LIPSCOMB ST NE STE 10
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2927
Practice Address - Country:US
Practice Address - Phone:813-906-6203
Practice Address - Fax:813-436-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty