MEDICARE: STARLIGHT ABA AZ LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134052921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARLIGHT ABA AZ LLC

Provider Business Mailing Address
First Line	:	10171 N 19TH AVE STE 10
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-1940
Country	:	US
Telephone Number	:	347-454-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	10171 N 19TH AVE STE 10
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-1940
Country	:	US
Telephone Number	:	347-454-6140
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ABRAHAM TYBERG
Credential	:
Telephone Number	:	347-454-6140

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “STARLIGHT ABA AZ LLC ” Practice Location

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