Provider Demographics
NPI:1588178149
Name:ADVENTURE ABA, LLC
Entity Type:Organization
Organization Name:ADVENTURE ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:623-693-4766
Mailing Address - Street 1:10150 W DESERT RIVER BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-3010
Mailing Address - Country:US
Mailing Address - Phone:623-693-2954
Mailing Address - Fax:
Practice Address - Street 1:10150 W DESERT RIVER BLVD STE 160
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-3010
Practice Address - Country:US
Practice Address - Phone:623-693-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-18
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ267103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ357819Medicaid