Provider Demographics
NPI:1003639014
Name:FLOURISH ABA LLC
Entity type:Organization
Organization Name:FLOURISH ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-676-2609
Mailing Address - Street 1:2331 VELP AVE STE H
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-6592
Mailing Address - Country:US
Mailing Address - Phone:920-676-2609
Mailing Address - Fax:
Practice Address - Street 1:2331 VELP AVE STE H
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-6592
Practice Address - Country:US
Practice Address - Phone:920-676-2609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty