Provider Demographics
NPI:1760109565
Name:ABA TREE OF FUNCTIONAL SKILLS LLC
Entity Type:Organization
Organization Name:ABA TREE OF FUNCTIONAL SKILLS LLC
Other - Org Name:ABA TREE OF FUNCTIONAL SKILLS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCABA
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GONZALEZ MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:321-287-1608
Mailing Address - Street 1:2378 WHITE CEDAR WAY
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4165
Mailing Address - Country:US
Mailing Address - Phone:321-287-1608
Mailing Address - Fax:
Practice Address - Street 1:2378 WHITE CEDAR WAY
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4165
Practice Address - Country:US
Practice Address - Phone:321-287-1608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty