Provider Demographics
NPI:1962886044
Name:BEHAVIOR & COGNITIVE THERAPY, INC.
Entity type:Organization
Organization Name:BEHAVIOR & COGNITIVE THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:ED D, LMHC, BCBA-D
Authorized Official - Phone:321-544-4351
Mailing Address - Street 1:201 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3303
Mailing Address - Country:US
Mailing Address - Phone:321-544-4351
Mailing Address - Fax:321-775-3484
Practice Address - Street 1:201 6TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3303
Practice Address - Country:US
Practice Address - Phone:321-544-4351
Practice Address - Fax:321-775-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7350101YM0800X
FL1-00-0132103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty