MEDICARE: ST. BASIL ABA SERVICES 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	:	1659229482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. BASIL ABA SERVICES LLC

Provider Business Mailing Address
First Line	:	1067 CARLISLE PL
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-1033
Country	:	US
Telephone Number	:	615-720-5265
Fax Number	:

Provider Business Practice Location Address
First Line	:	1067 CARLISLE PL
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-1033
Country	:	US
Telephone Number	:	615-720-5265
Fax Number	:

Authorized Official
Title or Position	:	OWNER/BCBA
Name	:	RETA MEDHAT FOUAD
Credential	:	M.S BCBA
Telephone Number	:	615-720-5265

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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