Provider Demographics
NPI:1952168080
Name:ABA FOOTPRINTS
Entity Type:Organization
Organization Name:ABA FOOTPRINTS
Other - Org Name:ABA FOOTPRINTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCBA, LBA
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:832-610-4372
Mailing Address - Street 1:40352 BLOSSOM VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4563
Mailing Address - Country:US
Mailing Address - Phone:832-610-4372
Mailing Address - Fax:
Practice Address - Street 1:40352 BLOSSOM VALLEY LN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4563
Practice Address - Country:US
Practice Address - Phone:832-610-4372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency