Proverbs 22:6 Behavioral Therapy Inc

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

PROVERBS 22:6 BEHAVIORAL THERAPY INC

Practice address

1086 SW Colorado Ave
Port St Lucie, FL 34953-1803

Phone

(305) 439-0263

Fax

(786) 288-3617

NPI assigned

Sep 16, 2020

Last updated

Sep 16, 2020By 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

Robert James Kidd, DPT

Title

President

Phone

(305) 439-0263

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1649886664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6365 COLLINS AVE APT 4406",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331419622",
            "telephone_number": "305-439-0263",
            "fax_number": "786-288-3617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 SW COLORADO AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349531803",
            "telephone_number": "305-439-0263",
            "fax_number": "786-288-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVERBS 22:6 BEHAVIORAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-439-0263",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002500900",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "PortStLucie",
            "affiliation": "N",
            "address_1": "1086 SW Colorado Ave",
            "city": "Port St Lucie",
            "state": "FL",
            "country_code": "US",
            "postal_code": "349531803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Behavior Analyst in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.