Provider Demographics
NPI:1780210955
Name:OAKTREE ABA SERVICES LLC
Entity Type:Organization
Organization Name:OAKTREE ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JETHRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-308-1594
Mailing Address - Street 1:7578 FM 455
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:76251-1258
Mailing Address - Country:US
Mailing Address - Phone:940-531-2330
Mailing Address - Fax:
Practice Address - Street 1:7578 FM 455
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:TX
Practice Address - Zip Code:76251-1258
Practice Address - Country:US
Practice Address - Phone:940-531-2330
Practice Address - Fax:
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