Provider Demographics
NPI:1629752894
Name:ABA DIRECT PLLC
Entity Type:Organization
Organization Name:ABA DIRECT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:THORBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:646-420-6837
Mailing Address - Street 1:19730 RALSTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1546
Mailing Address - Country:US
Mailing Address - Phone:770-865-7722
Mailing Address - Fax:404-806-6662
Practice Address - Street 1:19730 RALSTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1546
Practice Address - Country:US
Practice Address - Phone:770-865-7722
Practice Address - Fax:404-806-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty