Organization Active NPI

Fenix Behavior Therapy Co.

  • Behavior Analyst
  • Fort Myers, FL
National Provider Identifier
1184112906
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
FENIX BEHAVIOR THERAPY CO.
Practice address
1705 Colonial Blvd Ste B4
Fort Myers, FL 33907-1141
Phone
(239) 628-6999
NPI assigned
Apr 26, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Authorized official

Name
Sucel Tejeda, BCBA
Title
Clinical Director
Phone
(239) 628-6999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

1705 Colonial Blvd Ste B4
Fort Myers, FL 33907-1141

Mailing address

6660 Estero Blvd Unit B404
Fort Myers Beach, FL 33931-4567
Phone (239) 628-6999

Other practice location 1

2014 4th St Ste 6
Sarasota, FL 34237-4304
Phone (239) 224-9534

Other practice location 2

6660 Estero Blvd Unit B404
Fort Myers Beach, FL 33931-4567
Phone (239) 628-6999

National Provider Directory

National Provider Directory

Locations

12651 McGregor Blvd
Ste 501
Fort Myers, FL 33919
Phone (239) 628-6999

12557 New Brittany Blvd
Ste 3110
Fort Myers, FL 33907

1705 Colonial Blvd
Ste B4
Fort Myers, FL 33907
Phone (239) 628-6999

2014 4th St
Ste 6
Sarasota, FL 34237
Phone (239) 224-9534

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1184112906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6660 ESTERO BLVD UNIT B404",
            "city": "FORT MYERS BEACH",
            "state": "FL",
            "postal_code": "339314567",
            "telephone_number": "239-628-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 COLONIAL BLVD STE B4",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071141",
            "telephone_number": "239-628-6999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2014 4th St Ste 6",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342374304",
            "country_code": "US",
            "telephone_number": "239-224-9534",
            "fax_number": "888-391-5328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6660 Estero Blvd Unit B404",
            "address_purpose": "LOCATION",
            "city": "Fort Myers Beach",
            "state": "FL",
            "postal_code": "339314567",
            "country_code": "US",
            "telephone_number": "239-628-6999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FENIX BEHAVIOR THERAPY CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-26",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "TEJEDA",
        "authorized_official_first_name": "SUCEL",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "239-628-6999",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; 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.