Basic Information
| Provider Information | |||||||||
| NPI: | 1366990517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIOR QUEST LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4891 GLOVER LN | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325704556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506260606 | ||||||||
| FaxNumber: | 8503613443 | ||||||||
| Practice Location | |||||||||
| Address1: | 4891 GLOVER LN | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325704556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506260606 | ||||||||
| FaxNumber: | 8503613443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2016 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | MUELLER | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8505541077 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA | ||||||||
| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-08-4800 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.