NPIMap

Organization Active NPI

Behavior 180, LLC

  • Behavior Analyst
  • Longwood, FL
National Provider Identifier
1902365638
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
BEHAVIOR 180, LLC
Practice address
420 E Sr 434 Ste a
Longwood, FL 32750-5244
Phone
(407) 476-4908
Fax
(844) 839-5839
NPI assigned
Mar 12, 2019
Last updated
Dec 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

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

Authorized official

Name
Kimmesha C Troutman, M.A., BCBANPI 1619380961
Title
Owner
Phone
(407) 476-4908

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary
Behavior Technician 106S00000X

Addresses

Primary practice location

420 E Sr 434 Ste a
Longwood, FL 32750-5244

Mailing address

420 E Sr 434 Ste a
Longwood, FL 32750-5244
Phone (407) 476-4908

Other identifiers 1

IdentifierTypeStateIssuer
017645000MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL behavior180@gmail.com

National Provider Directory

National Provider Directory

Locations

3260 Stone Mountain Hwy
Snellville, GA 30078
Phone (702) 335-7535

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606867200000",
    "number": "1902365638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E SR 434 STE A",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505244",
            "telephone_number": "407-476-4908",
            "fax_number": "844-839-5839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E SR 434 STE A",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505244",
            "telephone_number": "407-476-4908",
            "fax_number": "844-839-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIOR 180, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-12",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A",
        "authorized_official_last_name": "TROUTMAN",
        "authorized_official_first_name": "KIMMESHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-476-4908",
        "authorized_official_credential": "M.A., BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017645000",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "behavior180@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email Address",
            "address_1": "1205 S Scott Ave",
            "city": "Sanford",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327712253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Longwood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.