Healthcare Provider Details

I. General information

NPI: 1386355584
Provider Name (Legal Business Name): INCLUSIVE ABA CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BOARDWALK DR # 490
FORT COLLINS CO
80525-3040
US

IV. Provider business mailing address

1525 PROSPECT ST STE 603
LAKEWOOD NJ
08701-4642
US

V. Phone/Fax

Practice location:
  • Phone: 303-616-1188
  • Fax: 303-616-1189
Mailing address:
  • Phone: 303-616-1188
  • Fax: 303-616-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JT GUTMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 303-616-1188