Provider Demographics
NPI:1952015828
Name:KEYSTONE ABA SERVICES
Entity Type:Organization
Organization Name:KEYSTONE ABA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:954-512-9873
Mailing Address - Street 1:6219 WOODHAVEN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6850
Mailing Address - Country:US
Mailing Address - Phone:954-512-9873
Mailing Address - Fax:
Practice Address - Street 1:8140 OKEECHOBEE BLVD STE B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2003
Practice Address - Country:US
Practice Address - Phone:786-393-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty