Provider Demographics
NPI:1447926787
Name:BAYSIDE BEHAVIOR SOLUTIONS
Entity type:Organization
Organization Name:BAYSIDE BEHAVIOR SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PLESS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:706-358-5186
Mailing Address - Street 1:6551 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7759
Mailing Address - Country:US
Mailing Address - Phone:706-358-5186
Mailing Address - Fax:
Practice Address - Street 1:6551 2ND AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7759
Practice Address - Country:US
Practice Address - Phone:706-358-5186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty