<Unavail>

LBN: Crystal Lake Supportive Environments
<Unavail> is an health care organization with primary practice located at 2710 Staten Ave Suite A, Orlando FL 32804-4211. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as the primary health care specialty. Crystal Lake Supportive Environments can be contacted via phone (407) 965-3018, or through Cook, Craig via phone (407) 965-3055.

Contact Information

Primary practice address
2710 Staten Ave Suite A Orlando FL 32804-4211
Phone: (407) 965-3018
Fax: (877) 690-2003
Website:
Map and Directions
Authorized official contact:
Name: Cook, Craig PH.D., BCBA-D
Phone: (407) 965-3055

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X

Profile Details

NPI number 1932535184
LBN Legal business name Crystal Lake Supportive Environments
DBA Doing business as <Unavail>
Authorized official Cook, Craig PH.D., BCBA-D
Entity Organization
Organization subpart 1 No
Enumeration date Sep 19th, 2013
Last updated Nov 18th, 2013 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932535184 NPPES
Florida MEDICAID 671009396

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