Healthcare Provider Details

I. General information

NPI: 1679240667
Provider Name (Legal Business Name): WILLOW ABA SERVICES LLC - GOLDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 S LINCOLN ST STE 209
LITTLETON CO
80122-2725
US

IV. Provider business mailing address

8000 S LINCOLN ST STE 209
LITTLETON CO
80122-2725
US

V. Phone/Fax

Practice location:
  • Phone: 720-319-7614
  • Fax:
Mailing address:
  • Phone: 720-319-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: VICKIE DOLAN
Title or Position: DIRECTOR OF OUTREACH
Credential:
Phone: 720-319-7614