Basic Information
| Provider Information | |||||||||
| NPI: | 1679006506 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEACHING INTERVENTIONS KEEPING INDIVIDUALITY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 HIBISCUS BLVD | ||||||||
| Address2: | |||||||||
| City: | MERRITT ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329525070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3219617831 | ||||||||
| FaxNumber: | 4079603009 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 HIBISCUS BLVD | ||||||||
| Address2: | |||||||||
| City: | MERRITT ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329525070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3219617831 | ||||||||
| FaxNumber: | 4079603009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | FIOL | ||||||||
| AuthorizedOfficialFirstName: | TIKI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3219617831 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.