Healthcare Provider Details

I. General information

NPI: 1972469062
Provider Name (Legal Business Name): BROADER HORIZONS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 SOUTH CT
EUSTIS FL
32726-7903
US

IV. Provider business mailing address

1508 SOUTH CT
EUSTIS FL
32726-7903
US

V. Phone/Fax

Practice location:
  • Phone: 714-913-5890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMBER L TRUJILLO
Title or Position: BCBA
Credential:
Phone: 714-913-5890