Healthcare Provider Details

I. General information

NPI: 1821831942
Provider Name (Legal Business Name): ROGUE ABA ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 W PEORIA AVE STE 1061
PHOENIX AZ
85029-5202
US

IV. Provider business mailing address

2760 W PEORIA AVE STE 1061
PHOENIX AZ
85029-5202
US

V. Phone/Fax

Practice location:
  • Phone: 603-692-8173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CF TRUE
Title or Position: CEO
Credential:
Phone: 603-692-8173