Provider Demographics
NPI:1063016038
Name:MAURA STACK ODEN LLC
Entity Type:Organization
Organization Name:MAURA STACK ODEN LLC
Other - Org Name:ABA SERVICES OF COLORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:CAITLIN
Authorized Official - Last Name:WAMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA BCBA
Authorized Official - Phone:970-355-5137
Mailing Address - Street 1:10700 E GEDDES AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4564
Mailing Address - Country:US
Mailing Address - Phone:720-670-9046
Mailing Address - Fax:720-294-0534
Practice Address - Street 1:10700 E GEDDES AVE STE 125
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-4564
Practice Address - Country:US
Practice Address - Phone:720-670-9046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1194186148Medicaid