Provider Demographics
NPI:1437714151
Name:ABA SERVICES OF THE SOUTH
Entity Type:Organization
Organization Name:ABA SERVICES OF THE SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:THEOBALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-366-2567
Mailing Address - Street 1:512 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-6568
Mailing Address - Country:US
Mailing Address - Phone:337-739-8005
Mailing Address - Fax:
Practice Address - Street 1:512 THOROUGHBRED DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-6568
Practice Address - Country:US
Practice Address - Phone:337-366-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty