Healthcare Provider Details

I. General information

NPI: 1205730785
Provider Name (Legal Business Name): PINE TREE ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 N FRONTAGE RD STE E
FAYETTEVILLE AR
72703-5036
US

IV. Provider business mailing address

3604 NW FRONTAGE RD STE 6
BENTONVILLE AR
72712-9254
US

V. Phone/Fax

Practice location:
  • Phone: 479-480-5804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ASHER LAX
Title or Position: MEMBER
Credential:
Phone: 479-480-5804