Basic Information
Provider Information | |||||||||
NPI: | 1366792814 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PAUL NAPIER BEHAVIORAL CONSULTATION SERVICES - DOCTORS LAKE, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | BEHAVIORAL CONSULTATION SERVICES-DOCTORS LAKE | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3509 US HIGHWAY 17 | ||||||||
Address2: |   | ||||||||
City: | FLEMING ISLAND | ||||||||
State: | FL | ||||||||
PostalCode: | 320037122 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9045793280 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 10175 FORTUNE PKWY UNIT 903 | ||||||||
Address2: |   | ||||||||
City: | JACKSONVILLE | ||||||||
State: | FL | ||||||||
PostalCode: | 322566755 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9045380713 | ||||||||
FaxNumber: | 9045380714 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/12/2012 | ||||||||
LastUpdateDate: | 09/12/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NAPIER | ||||||||
AuthorizedOfficialFirstName: | PAUL | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 9045380713 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | BCBA | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |   |
No ID Information.