Provider Demographics
NPI:1629938667
Name:MINDSPROUT ABA LLC
Entity type:Organization
Organization Name:MINDSPROUT ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BREONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:510-877-2786
Mailing Address - Street 1:5940 S RAINBOW BLVD # 1182
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2540
Mailing Address - Country:US
Mailing Address - Phone:213-222-6474
Mailing Address - Fax:213-281-0521
Practice Address - Street 1:5139 FIJI ISLAND CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0976
Practice Address - Country:US
Practice Address - Phone:213-222-6474
Practice Address - Fax:213-281-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty