Provider Demographics
NPI:1972186740
Name:DEEP BLUE ABA, LLC
Entity Type:Organization
Organization Name:DEEP BLUE ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:LORENA
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-490-3687
Mailing Address - Street 1:2821 TORREYA CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3699
Mailing Address - Country:US
Mailing Address - Phone:214-490-3687
Mailing Address - Fax:
Practice Address - Street 1:2821 TORREYA CT
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3699
Practice Address - Country:US
Practice Address - Phone:214-490-3687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty