Provider Demographics
NPI:1497432371
Name:MINDFUL MILESTONES ABA LLC
Entity Type:Organization
Organization Name:MINDFUL MILESTONES ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELLE ILE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:BUCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-529-1742
Mailing Address - Street 1:675 HENSON FARM DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6528
Mailing Address - Country:US
Mailing Address - Phone:561-529-1742
Mailing Address - Fax:
Practice Address - Street 1:1775 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9118
Practice Address - Country:US
Practice Address - Phone:561-529-1742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty