Healthcare Provider Details

I. General information

NPI: 1780554055
Provider Name (Legal Business Name): GREENLIGHT ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 N 44TH DRIVE UNIT 1108
GLENDALE AZ
85301
US

IV. Provider business mailing address

7828 W COLLEGE DR
PHOENIX AZ
85033-1134
US

V. Phone/Fax

Practice location:
  • Phone: 877-881-3090
  • Fax:
Mailing address:
  • Phone: 602-363-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEVIN ROSAS
Title or Position: BEHAVIORAL TECHNICIAN
Credential:
Phone: 602-363-5967