Provider Demographics
NPI:1598179426
Name:EXCEL ABA LLC
Entity Type:Organization
Organization Name:EXCEL ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:713-515-7196
Mailing Address - Street 1:1618 LEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5025
Mailing Address - Country:US
Mailing Address - Phone:713-515-7196
Mailing Address - Fax:
Practice Address - Street 1:1618 LEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5025
Practice Address - Country:US
Practice Address - Phone:713-515-7196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health