Healthcare Provider Details

I. General information

NPI: 1952015828
Provider Name (Legal Business Name): KEYSTONE ABA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 OKEECHOBEE BLVD STE B
WEST PALM BEACH FL
33411-2003
US

IV. Provider business mailing address

6219 WOODHAVEN VILLAGE DR
PORT ORANGE FL
32128-6850
US

V. Phone/Fax

Practice location:
  • Phone: 786-393-0315
  • Fax:
Mailing address:
  • Phone: 954-512-9873
  • 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: MR. TREVOR ARTHUR HANSEN
Title or Position: OWNER
Credential: MSW
Phone: 954-512-9873