Healthcare Provider Details

I. General information

NPI: 1861128027
Provider Name (Legal Business Name): SEEDS OF ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20860 N TATUM BLVD STE 300
PHOENIX AZ
85050-4283
US

IV. Provider business mailing address

20860 N TATUM BLVD STE 300
PHOENIX AZ
85050-4283
US

V. Phone/Fax

Practice location:
  • Phone: 866-342-8847
  • Fax: 866-342-8847
Mailing address:
  • Phone: 866-342-8847
  • Fax: 866-342-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: OOSHIE OLDHAM
Title or Position: CEO
Credential:
Phone: 866-342-8847