Provider Demographics
NPI:1164011482
Name:MINDFUL ABA SERVICES LLC
Entity Type:Organization
Organization Name:MINDFUL ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:CORAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEIR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:954-305-4201
Mailing Address - Street 1:3014 W LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1649
Mailing Address - Country:US
Mailing Address - Phone:954-305-4201
Mailing Address - Fax:
Practice Address - Street 1:3014 W LAWN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1649
Practice Address - Country:US
Practice Address - Phone:954-305-4201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105592400Medicaid