Provider Demographics
NPI:1477043255
Name:ABA SCHOOLHOUSE
Entity Type:Organization
Organization Name:ABA SCHOOLHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGEFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:ABA
Authorized Official - Phone:805-325-1421
Mailing Address - Street 1:9221 E BASELINE RD STE 109NO242
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8310
Mailing Address - Country:US
Mailing Address - Phone:805-325-1421
Mailing Address - Fax:480-939-3596
Practice Address - Street 1:9221 E BASELINE RD STE 109NO242
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-8310
Practice Address - Country:US
Practice Address - Phone:805-325-1421
Practice Address - Fax:480-939-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty