Healthcare Provider Details

I. General information

NPI: 1336064336
Provider Name (Legal Business Name): BLUE MOON ABA CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 E HAMPDEN AVE STE 400
DENVER CO
80231-4844
US

IV. Provider business mailing address

7535 E HAMPDEN AVE STE 400
DENVER CO
80231-4844
US

V. Phone/Fax

Practice location:
  • Phone: 609-322-1516
  • Fax: 609-888-8122
Mailing address:
  • Phone: 609-322-1516
  • Fax: 609-888-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARA LEA SAURYMPER
Title or Position: CEO
Credential:
Phone: 609-322-1516