Provider Demographics
NPI:1265032411
Name:HUMMINGBIRD ABA THERAPY, LLC
Entity type:Organization
Organization Name:HUMMINGBIRD ABA THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANGSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, LBS
Authorized Official - Phone:814-380-9180
Mailing Address - Street 1:2160 SANDY DR STE D
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2205
Mailing Address - Country:US
Mailing Address - Phone:814-380-9180
Mailing Address - Fax:814-406-4244
Practice Address - Street 1:2160 SANDY DR STE D
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2205
Practice Address - Country:US
Practice Address - Phone:814-380-9180
Practice Address - Fax:814-406-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038509600004Medicaid
1770193708OtherNPI (TYPE 1)