Healthcare Provider Details

I. General information

NPI: 1174415004
Provider Name (Legal Business Name): SPIRIT ABA CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 S FIDDLERS GREEN CIR STE 300E
GREENWOOD VILLAGE CO
80111-4831
US

IV. Provider business mailing address

6312 S FIDDLERS GREEN CIR STE 300E
GREENWOOD VILLAGE CO
80111-4831
US

V. Phone/Fax

Practice location:
  • Phone: 732-267-4591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK KAUFMAN
Title or Position: MANAGER
Credential:
Phone: 303-276-3995