Basic Information
| Provider Information | |||||||||
| NPI: | 1760627905 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APPLIED BEHAVIORAL LEARNING EXPERIENCES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2112 | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338062112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8635811583 | ||||||||
| FaxNumber: | 8636449590 | ||||||||
| Practice Location | |||||||||
| Address1: | 454 W PIPKIN RD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338132545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636192809 | ||||||||
| FaxNumber: | 8636469590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2008 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | OSMON | ||||||||
| AuthorizedOfficialFirstName: | STACEY | ||||||||
| AuthorizedOfficialMiddleName: | LYN | ||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIOR ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 8635811583 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.S. ED, BCBA | ||||||||
| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 017634700 | 05 | FL | MEDICAID | 687700196 | 05 | FL | MEDICAID |