Provider Demographics
NPI:1558197368
Name:EDNA BEHAVIORAL SOLUTIONS
Entity type:Organization
Organization Name:EDNA BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYLON
Authorized Official - Middle Name:V
Authorized Official - Last Name:MALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-866-8749
Mailing Address - Street 1:6543 MERITMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-2290
Mailing Address - Country:US
Mailing Address - Phone:321-460-3581
Mailing Address - Fax:
Practice Address - Street 1:6543 MERITMOOR CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-2290
Practice Address - Country:US
Practice Address - Phone:321-460-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty