Full Spectrum Behavioral Analysis LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-14-15276

Legal business name

FULL SPECTRUM BEHAVIORAL ANALYSIS LLC

Practice address

16414 Lake Church Dr
Odessa, FL 33556-2637

Phone

(813) 205-2715

Fax

(813) 920-9252

NPI assigned

Oct 22, 2014

Last updated

Nov 24, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carroll Edward Streetman Jr., RN

Title

President

Phone

(813) 205-2715

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448323200000",
    "number": "1174928931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16414 LAKE CHURCH DR",
            "city": "ODESSA",
            "state": "FL",
            "postal_code": "335562637",
            "telephone_number": "813-205-2715",
            "fax_number": "813-920-9252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16414 LAKE CHURCH DR",
            "city": "ODESSA",
            "state": "FL",
            "postal_code": "335562637",
            "telephone_number": "813-205-2715",
            "fax_number": "813-920-9252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SPECTRUM BEHAVIORAL ANALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2015-11-24",
        "status": "A",
        "authorized_official_last_name": "STREETMAN",
        "authorized_official_first_name": "CARROLL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-205-2715",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-14-15276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Odessa, FL
• Providers in Odessa, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2015; 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.