Provider Demographics
NPI:1972173227
Name:BEHAVIORAL INTERVENTION THERAPY SERVICES LLC
Entity type:Organization
Organization Name:BEHAVIORAL INTERVENTION THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-398-5309
Mailing Address - Street 1:4273 SW MCCLELLEN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6135
Mailing Address - Country:US
Mailing Address - Phone:561-398-5309
Mailing Address - Fax:
Practice Address - Street 1:3212 OLEANDER AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-6426
Practice Address - Country:US
Practice Address - Phone:772-233-6446
Practice Address - Fax:772-264-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL841447Medicaid