MEDICARE: AVENUE BEAN ABA, 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	:	1215890272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENUE BEAN ABA, LLC

Provider Business Mailing Address
First Line	:	41444 LILY AVE
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-2113
Country	:	US
Telephone Number	:	310-218-6488
Fax Number	:

Provider Business Practice Location Address
First Line	:	41444 LILY AVE
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-2113
Country	:	US
Telephone Number	:	310-218-6488
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHANIE L CHANEY
Credential	:
Telephone Number	:	310-218-6488

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/12/2025

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