Healthcare Provider Details

I. General information

NPI: 1760316079
Provider Name (Legal Business Name): ELEVATE ABA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8231 GREENBUSH AVE
PANORAMA CITY CA
91402-5514
US

IV. Provider business mailing address

7865 GOODLAND AVE
NORTH HOLLYWOOD CA
91605-2043
US

V. Phone/Fax

Practice location:
  • Phone: 818-800-4331
  • Fax: 213-693-1162
Mailing address:
  • Phone: 623-777-7770
  • Fax: 213-693-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KIM MITCHELL POTTER
Title or Position: CREDENTIALING SPECIALIST
Credential: BCBA LBA LBS
Phone: 201-978-3815