Taylor Detherow

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-20-45584 Issued in FL

Practice address

3771 Stefani Rd
Cantonment, FL 32533-7795

Phone

(850) 607-6910

Fax

(850) 607-6932

NPI assigned

Jan 7, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• ABA Lyfe, PLLC

  • Community/Behavioral Health Agency
  • Fort Walton Beach, FL
  • NPI 1417639287
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604188800000",
    "number": "1033626437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 PINEVIEW BLVD UNIT C",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471499",
            "telephone_number": "925-337-7384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3771 STEFANI RD",
            "city": "CANTONMENT",
            "state": "FL",
            "postal_code": "325337795",
            "telephone_number": "850-607-6910",
            "fax_number": "850-607-6932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETHEROW",
        "first_name": "TAYLOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-07",
        "last_updated": "2020-11-01",
        "certification_date": "2020-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "FL",
            "license": "10190",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "35476",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-20-45584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tami Cyr
• Robert Thomas Davies
• Davine Counseling Center, LLC
• Lacie Ann Day
• Carmen R Delarosa, MD
• Sydnee Alexis Detrie
• Cassandra Jean Devlin
• Erica Diaz
• Digestive Health & Primary Care Clinic, LLC
• Emily Kate Donald

• All providers in Cantonment, FL
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.