MEDICARE: NEUROINCLUSIVE 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	:	1609710938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROINCLUSIVE ABA LLC

Provider Business Mailing Address
First Line	:	7053 S SANTA CRUZ DR APT 21
Second Line	:	21
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-6687
Country	:	US
Telephone Number	:	385-598-5237
Fax Number	:

Provider Business Practice Location Address
First Line	:	7053 S SANTA CRUZ DR APT 21
Second Line	:	21
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-6687
Country	:	US
Telephone Number	:	385-598-5237
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLE SMITH
Credential	:	MASTERS IN ABA
Telephone Number	:	385-598-5237

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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