Provider Demographics
NPI:1952046039
Name:WILLOW ABA SERVICES LLC
Entity Type:Organization
Organization Name:WILLOW ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-319-7614
Mailing Address - Street 1:8000 S LINCOLN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2725
Mailing Address - Country:US
Mailing Address - Phone:405-408-3941
Mailing Address - Fax:
Practice Address - Street 1:609A PINER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-4201
Practice Address - Country:US
Practice Address - Phone:720-319-7614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty