Healthcare Provider Details

I. General information

NPI: 1619890936
Provider Name (Legal Business Name): MOMENTUM ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17595 S TAMIAMI TRL STE 250E
FORT MYERS FL
33908-4570
US

IV. Provider business mailing address

17595 S TAMIAMI TRL STE 250E
FORT MYERS FL
33908-4570
US

V. Phone/Fax

Practice location:
  • Phone: 239-933-7034
  • Fax:
Mailing address:
  • Phone: 239-933-7034
  • 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: BRIAN CORREA
Title or Position: OWNER
Credential:
Phone: 239-933-7034