Healthcare Provider Details

I. General information

NPI: 1295572758
Provider Name (Legal Business Name): SOCIALLY BEAUTIFUL ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 W WOODMEN RD
COLORADO SPRINGS CO
80919-3880
US

IV. Provider business mailing address

6660 DELMONICO DR STE D325
COLORADO SPRINGS CO
80919-1899
US

V. Phone/Fax

Practice location:
  • Phone: 469-307-7471
  • Fax:
Mailing address:
  • Phone: 719-428-0483
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ARIANE ANTIONETTE MADISON
Title or Position: CLINICAL DIRECTOR- BCBA
Credential: M.ED, BCBA
Phone: 719-428-0483