MEDICARE: ABA TREEHOUSE

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1679426928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA TREEHOUSE

Provider Business Mailing Address
First Line	:	1616 CONCIERGE BLVD FL 1
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-7158
Country	:	US
Telephone Number	:	386-383-4562
Fax Number	:	386-401-2385

Provider Business Practice Location Address
First Line	:	1616 CONCIERGE BLVD FL 1
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-7158
Country	:	US
Telephone Number	:	386-383-4562
Fax Number	:	386-401-2385

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIE WALLACE
Credential	:
Telephone Number	:	386-383-4562

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ABA TREEHOUSE ” Practice Location

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