Provider Demographics
NPI:1942504725
Name:ABA FOR AUTISM GROUP, LLC
Entity Type:Organization
Organization Name:ABA FOR AUTISM GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-992-4626
Mailing Address - Street 1:1472 BLOOMIN SPRING CT
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-7221
Mailing Address - Country:US
Mailing Address - Phone:859-992-4626
Mailing Address - Fax:
Practice Address - Street 1:1472 BLOOMIN SPRING CT
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-7221
Practice Address - Country:US
Practice Address - Phone:859-992-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty