Healthcare Provider Details

I. General information

NPI: 1104741420
Provider Name (Legal Business Name): AUTISM THERAPY ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 PALM DR
MELBOURNE BEACH FL
32951-3204
US

IV. Provider business mailing address

5025 PALM DR
MELBOURNE BEACH FL
32951-3204
US

V. Phone/Fax

Practice location:
  • Phone: 321-795-2768
  • Fax:
Mailing address:
  • Phone: 321-795-2768
  • 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: COLE SMITH
Title or Position: CEO
Credential:
Phone: 321-795-2768