Provider Demographics
NPI:1366017857
Name:POSITIVE CHANGE ABA LLC
Entity Type:Organization
Organization Name:POSITIVE CHANGE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA, LBA
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:417-294-1178
Mailing Address - Street 1:436 TUMBLEWEED PASS
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-8541
Mailing Address - Country:US
Mailing Address - Phone:417-294-1178
Mailing Address - Fax:
Practice Address - Street 1:436 TUMBLEWEED PASS
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-8541
Practice Address - Country:US
Practice Address - Phone:417-294-1178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty