Provider Demographics
NPI:1710513940
Name:ABA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ABA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:850-376-5624
Mailing Address - Street 1:732 MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3175
Mailing Address - Country:US
Mailing Address - Phone:850-376-5624
Mailing Address - Fax:850-937-7381
Practice Address - Street 1:103 RICKEY AVE UNIT C
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2520
Practice Address - Country:US
Practice Address - Phone:850-376-5624
Practice Address - Fax:850-937-7381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty