Provider Demographics
NPI:1245703206
Name:AMYS ABA THERAPY SERVICES
Entity type:Organization
Organization Name:AMYS ABA THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-763-9333
Mailing Address - Street 1:6859 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2336
Mailing Address - Country:US
Mailing Address - Phone:847-763-9333
Mailing Address - Fax:
Practice Address - Street 1:5250 OLD ORCHARD RD STE 300
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4462
Practice Address - Country:US
Practice Address - Phone:800-975-6164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty