Provider Demographics
NPI:1023884178
Name:PROGRESSIVE ABA SOLUTIONS AND TRAINING
Entity type:Organization
Organization Name:PROGRESSIVE ABA SOLUTIONS AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-983-1124
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92572-1296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22910 COUNTRY SQUIRE RD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-8108
Practice Address - Country:US
Practice Address - Phone:818-983-1124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty