NPIMap

Organization Active NPI

Southlake Autism and Behavior Services, PA

  • Community/Behavioral Health Agency
  • Clermont, FL
National Provider Identifier
1396017414
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
0-11-4087 Issued in FL
Legal business name
SOUTHLAKE AUTISM AND BEHAVIOR SERVICES, PA
Practice address
350 Acceptance Way
Clermont, FL 34711
Phone
(352) 223-1999
NPI assigned
Feb 5, 2012
Last updated
May 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Authorized official

Name
Mrs. Terri Howard, BCBANPI 1083906184
Title
Clinical Director/Behavior Analyst
Phone
(352) 223-1999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 0-11-4087 FL
Developmentally Disabled Services Day Training Agency 251C00000X 0-11-4087 FL
Early Intervention Provider Agency 252Y00000X 0-11-4087 FL
In Home Supportive Care Agency 253Z00000X 0-11-4087 FL
Community/Behavioral Health Agency 251S00000X 0-11-4087 FL Primary

Addresses

Primary practice location

350 Acceptance Way
Clermont, FL 34711

Mailing address

13201 Sugarbluff Rd
Clermont, FL 34715-6819
Phone (352) 978-5903

Other practice location 1

365 Citrus Tower Blvd Ste 106
Clermont, FL 34711-6532
Phone (352) 223-1999

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 69

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1328400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1396017414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13201 SUGARBLUFF RD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347156819",
            "telephone_number": "352-978-5903",
            "fax_number": "352-600-3119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 ACCEPTANCE WAY",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "34711",
            "telephone_number": "352-223-1999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "365 Citrus Tower Blvd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Clermont",
            "state": "FL",
            "postal_code": "347116532",
            "country_code": "US",
            "telephone_number": "352-223-1999",
            "fax_number": "352-600-3119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHLAKE AUTISM AND BEHAVIOR SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-05",
        "last_updated": "2021-05-05",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR/BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "352-223-1999",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "FL",
            "license": "0-11-4087",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": "0-11-4087",
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "FL",
            "license": "0-11-4087",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "FL",
            "license": "0-11-4087",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "0-11-4087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; 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.